Impact of Direct-Acting Antivirals on the Hemodynamics of the Portal Circulation in Cirrhotic Patients Infected with Hepatitis C Virus

Alshymaa A Hassnine; Amr M Elsayed; Mahmoud M Higazi; Mery Saied; Abbas Abbas; Mohamed Mamdouh; Elham Ahmed; Wael Soliman

doi:10.1159/000549612

Impact of Direct-Acting Antivirals on the Hemodynamics of the Portal Circulation in Cirrhotic Patients Infected with Hepatitis C Virus

Digestion. 2025 Dec 15:1-8. doi: 10.1159/000549612. Online ahead of print.

Authors

Alshymaa A Hassnine¹, Amr M Elsayed², Mahmoud M Higazi³, Mery Saied⁴, Abbas Abbas⁵, Mohamed Mamdouh⁶, Elham Ahmed⁶, Wael Soliman²

Affiliations

¹ Department of Tropical Medicine, Faculty of Medicine, Minia University, Minia, Egypt, alshiamaa.ahmed@mu.edu.eg.
² Department of Tropical Medicine, Faculty of Medicine, Minia University, Minia, Egypt.
³ Department of Radiology, Faculty of Medicine, Minia University, Minia, Egypt.
⁴ Department of Clinical Pathology, Faculty of Medicine, Minia University, Minia, Egypt.
⁵ Department of Biochemistry, Faculty of Medicine, Cairo University, Giza, Egypt.
⁶ Department of Internal Medicine, Faculty of Medicine, Minia University, Minia, Egypt.

PMID: 41396882
DOI: 10.1159/000549612

Abstract

Introduction: The most frequent cause of portal hypertension is liver cirrhosis (LC). Chronic hepatitis C virus (HCV) is a major cause of death and morbidity globally because of the consequences of LC, hepatocellular carcinoma, and portal hypertension, oral direct-acting antivirals (DAAs) are the effective treatment for HCV, offering a high cure rate. A virological response is also anticipated to improve portal hypertension. The aim of the study was to assess how DAA medication affects the hemodynamics of the portal circulation in patients with cirrhosis who have been infected with HCV.

Methods: A total of 120 patients with LC linked to chronic HCV were included in this study. They received treatment using regimens based on sofosbuvir combined with daclatasvir and either ribavirin or neither. Prior to beginning therapy and 2 years later, all patients underwent the following tests: complete blood count, PCR for HCV RNA, liver and renal function, abdominal ultrasonography, and colored duplex for assessment of portal hypertension.

Results: When compared to Doppler parameters prior to treatment, there is a notable improvement in Doppler metrics following DAA therapy (p = 0.006), including portal vein (PV) diameter, portal congestive index, PV cross-sectional area, splenic vein diameter, and span. Only roughly 69 patients (or 57% of the total) showed an improvement in portal pressure, whereas the percentage of sustained virological response is 95%. Numerous characteristics, such as the existence of splenomegaly and varices, a history of bilharzias, a high degree of fibrosis, and a low platelet count prior to treatment, are linked to non-changes in portal hypertension.

Conclusion: We infer that sustained virological response in HCV related cirrhotic patients following DAAs may lead to decrease in portal hypertension after an extended period of time, as adopted from portal congestion index Doppler parameters.

Keywords: Direct-acting antivirals; Doppler assessment; Hepatitis C virus; Liver cirrhosis; Portal circulation.