Broquetas T, Herruzo-Pino P, Mariño Z, et al. - Even after normalization of liver function parameters, serological non-invasive testing, and transient elastography (TE) values, cirrhosis is evident in more than half of hepatitis C virus (HCV)-compensated advanced chronic liver disease (cACLD) patients 3 years after the sustained virological response (SVR). The limited diagnostic accuracy of non-invasive approaches after SVR emphasizes the importance of long-term monitoring.

• It was a prospective, multi-centric study.

• Seventy-six (10.2%) of 746 HCV-infected patients (95.4% with TE ≥ 10 kPa) had a liver biopsy 3 years after SVR. Prior to therapy, 46 (63%) displayed a TE> 15 kPa.

• After SVR, the TE before DAA was the strongest predictor of cirrhosis (METAVIR, F4).

• After SVR, liver function parameters, serological non-invasive tests (APRI and FIB-4), and TE values all improved.

• However, 41 patients (53.9%) had cirrhosis after a liver biopsy 3 years after HCV-elimination (median time= 38.4 months).

• According to multivariate analysis, the only variables associated with cirrhosis after SVR were HCV-genotype 3 and TE prior to treatment.

• The accuracy of TE following SVR, on the other hand, was poor, and 6 (27.3%) of 22 patients with a TE < 8 kPa had cirrhosis.

• APRI and FIB-4 scores yielded similar findings.