Z Gastroenterol 2015; 53 - P100
DOI: 10.1055/s-0035-1551788

Decrease in liver fibrosis after achieving SVR in patients with chronic Hepatitis C infection

K Kozbial 1, S Beinhardt 1, C Freissmuth 1, A Stättermayer 1, R Stern 1, P Munda 1, M Trauner 1, P Ferenci 1, H Hofer 1
  • 1Medizinische Universität Wien, Innere Med. III, Gastroenterologie und Hepatologie, Vienna, Austria

Background and Aims: Liver fibrosis progressing to liver cirrhosis is a consequence of chronic hepatitis C virus (HCV) infection. Antiviral therapy is aimed to eliminate HCV in order to prevent disease progression and late complications of cirrhosis. The aim of this study was to evaluate the long term effect of sustained virological response (SVR) on liver fibrosis.

Methods: Liver stiffness (by FibroScan®) was examined in 67 sustained virologic responders to pegInterferon/ribavirin alone or in combination with a protease-inhibitor and in 29 nonresponders during follow-up (median: 6.0 years; range 1 – 15). All patients (63 [65.6%] male, mean age: 58.0 ± 9.0 years, GT1: 69 [71.9%], GT2: 2 [2.1%], GT3: 10 [10.4%], GT4: 9 [9.4%], unknown GT: 6 [6.3%]) had a liver biopsy prior to treatment. Stage of fibrosis in the pretreatment biopsy was determined according to Metavir. Liver fibrosis categories by FibroScan® were defined as: no/minimal fibrosis (F0 – 1: < 7.0kPa), moderate/advanced fibrosis (F2 – 3: 7.0 – 12.4kPa), and cirrhosis (F4: ≥12.5kPa).

Results: 45 (46.9%), 47 (49.0%) and 4 (4.2%) patients in the overall cohort had cirrhosis, fibrosis F2/3 or no/minimal fibrosis in pretreatment liver biopsy, respectively. After treatment the proportion of patients with F4 in the overall cohort decreased (F4: pretreatment: 45/96 [46.9%] vs. follow-up: 21/96 [21.9%]; p < 0.01), which was mainly due to a decrease of cirrhosis in SVR patients (36.5% vs. 13.5%, table 1). Twenty-three of 35 (62.9%) cirrhotic SVR patients (F4) showed regression into pre-cirrhotic fibrosis stages and the number of F0-F1 patients increased after achieving SVR from 3.1% to 35.4%.

Tab. 1: Stage of fibrosis in SVR and non-SVR patients prior and after antiviral treatment.

Pretreatment – liver biopsy

Posttreatment – FibroScan®

F0-F1

F2-F3

F4

F0-F1

F2-F3

F4

SVR

3 (3.1%)

29 (30.2%)

35 (36.5%)

34 (35.4%)

20 (20.8%)

13 (13.5%)

No SVR

1 (1.0%)

18 (18.8%)

10 (10.4%)

5 (5.2%)

16 (16.7%)

8 (8.3%)

Conclusions: Liver fibrosis improves in a high proportion of patients with chronic hepatitis C after successful eradication of the virus with regression of cirrhosis in approximately two thirds.