Tag-Adeen M, et al. - This study was performed to examine the effect of hepatitis C virus (HCV) genotype-4 eradication following direct-acting antiviral (DAA) on liver stiffness measurement (LSM). The researchers observed significant LSM improvement after successful HCV eradication; the best improvement occurred in F4 patients. Early detection and treatment were highly recommended, as the majority of cirrhotics were still at risk for liver decompensation and hepatocellular carcinoma development despite achieving sustained virologic response-24 (SVR-24).

• The researchers included 84 chronic HCV Egyptian patients.
• They conducted this study at Qena University Hospital from November 1, 2015, till October 31, 2016.
• They obtained LSM by FibroScan before starting DAA treatment and after achieving sustained virologic response-24 (SVR-24).
• Patients were stratified into F0-F1, F2, F3 and F4 groups (METAVIR) based on baseline LSM.
• They compared LSM and laboratory data after achieving SVR-24 with that before starting therapy in each fibrosis group (F0-F4), p-value <0.05 was statistically significant.

• 80 patients achieved SVR-24 following DAA treatment.
• Among them, 50 were males (62.5%), mean age: 54.2±7.6 years, and mean body mass index: 28.6±2.2 kg/m².
• Post-SVR, mean baseline LSM dropped from 15.6±10.8 to 12.1±8.7 kPa; the maximum change of -5.8 occurred in F4 vs. -2.79, -1.28 and +0.08 in F3, F2 and F0-F1 respectively (p<0.0001).
• 41 patients were in the F4 group at baseline.
• Out of them, only 16 (39%) regressed to non-cirrhotic range (<12.5 kPa), whereas 25 (61%) were still cirrhotic despite achieving SVR-24 (p<0.0001).
• Patients who achieved LSM improvement (n=64) reported significantly higher baseline aspartate transferase (AST) and alanine transaminase (ALT).
• After achieving SVR, those patients demonstrated significant improvement in AST, AST/platelets ratio index (APRI) and fibrosis-4 index (Fib-4); 91% showed AST improvement (p=0.01) and APRI improvement (p=0.01) and 81% showed Fib-4 improvement (p=0.04).
• Compared to their counterparts, females, diabetics, patients with S3 steatosis and patients older than 50 years showed less LSM improvements.
• Significant predictors for LSM improvement were baseline LSM ≥9 kPa, bilirubin ≥1 mg/dl, ALT ≥ 36 U/L and AST ≥31 U/L.