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Early fibrosis regression by shear wave elastography after successful direct-acting anti-HCV therapy

  • Mohamed Ahmed Samy KohlaEmail author
  • Ahmed El Fayoumi
  • Mohamed Akl
  • Mervat Abdelkareem
  • Mahmoud Elsakhawy
  • Sally Waheed
  • Mai Abozeid
Original Article
  • 63 Downloads

Abstract

Shear wave elastography (SWE) is a noninvasive ultrasound-based marker of hepatic fibrosis not requiring a special device. Successful direct-acting anti-HCV therapy was associated with hepatic fibrosis regression assessed by transient elastography (FibroScan). Data on the utility of SWE in these patients and how early fibrosis can regress after treatment are still lacking. To assess liver fibrosis by SWE before and after direct-acting antiviral treatment of chronic hepatitis C (CHC), we enrolled 165 CHC genotype 4 Egyptian patients treated with different Sofosbuvir-based regimens. Patients’ laboratory characteristics, fibrosis biomarkers, namely Fibrosis-4 (FIB-4) index and AST/platelet ratio index (APRI) and liver stiffness measurements (LSM) by SWE were evaluated at baseline, end of treatment (EOT at week 12), week 24 and week 36. Serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels as well as FIB-4 and APRI indices decreased significantly at EOT, week 24 and week 36 in comparison to baseline (P value < 0.001). Although platelet counts did not significantly differ between baseline and EOT, they increased significantly from EOT to week 24 and week 36 with a P value < 0.001. The mean LSM showed improvement at EOT (7.01 ± 3.59 kpa), week 24 (6.18 ± 3.39 kpa) and week 36 (5.74 ± 3.21 kpa) in comparison to baseline (8.49 ± 0.83 kpa) (P value < 0.001). There is early liver fibrosis regression at EOT and throughout the time after successful treatment with direct-acting antiviral agents (DAAs). SWE is a feasible, easily applicable noninvasive relatively inexpensive assessment method of liver fibrosis.

Keywords

Liver fibrosis Shear wave elastography Direct-acting antiviral drugs Hepatitis C 

Notes

Acknowledgements

We deeply thank the viral hepatitis treatment clinic team at the National liver institute, Menoufia University, Egypt for their help & support.

Authors’ contribution

MASK, MA, MA: Design of the study. AEF, MA, MA, ME: Data Collection. ME, AEF: Procedures (LSM). MASK, MA, SW: Data analysis. MASK, MA, AEF: Manuscript writing. SW, MASK, MA: Revision, editing & rewriting.

Funding

None.

Compliance with ethical standards

Conflict of interest

All the authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the institutional review board of the National Liver Institute, Menoufia University and was conducted in compliance with the Declaration of Helsinki.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Lombardi A, Mondelli MU. Hepatitis C: Is eradication possible? Liver Int. 2019;39:416–26.CrossRefGoogle Scholar
  2. 2.
    Gomaa A, Allam N, Elsharkawy A, El Kassas M, Waked I. Hepatitis C infection in Egypt: prevalence, impact and management strategies. Hepat Med. 2017;9:17–25.CrossRefGoogle Scholar
  3. 3.
    Lee UE, Friedman SL. Mechanisms of hepatic fibrogenesis. Best Pract Res Clin Gastroenterol. 2011;25:195–206.CrossRefGoogle Scholar
  4. 4.
    Refaat B, Ashshi AM, El-Shemi AG, AlZanbagi A. Effects of chronic hepatitis C genotype 1 and 4 on serum activins and follistatin in treatment naïve patients and their correlations with interleukin-6, tumour necrosis factor-α, viral load and liver damage. Clin Exp Med. 2015;15:293–302.CrossRefGoogle Scholar
  5. 5.
    Latif HA, Assal HS, Mahmoud M, Rasheed WI. Role of serum adiponectin level in the development of liver cirrhosis in patients with hepatitis C virus. Clin Exp Med. 2011;11:123–9.CrossRefGoogle Scholar
  6. 6.
    Ellis EL, Mann DA. Clinical evidence for the regression of liver fibrosis. J Hepatol. 2012;56:1171–80.CrossRefGoogle Scholar
  7. 7.
    Degos F, Perez P, Roche B, et al. Diagnostic accuracy of FibroScan and comparison to liver fibrosis biomarkers in chronic viral hepatitis: a multicenter prospective study (the FIBROSTIC study). J Hepatol. 2010;53:1013–21.CrossRefGoogle Scholar
  8. 8.
    Omran D, Yosry A, Darweesh SK, et al. Enhanced liver fibrosis test using ELISA assay accurately discriminates advanced stage of liver fibrosis as determined by transient elastography fibroscan in treatment naïve chronic HCV patients. Clin Exp Med. 2018;18:45–50.CrossRefGoogle Scholar
  9. 9.
    Kohla MAS, Abbasy M, Abozeid M, et al. Assessment of liver fibrosis with acoustic radiation force impulse imaging versus liver histology in patients with chronic hepatitis C: a pilot study. Eur J Gastroenterol Hepatol. 2017;29:951–5.CrossRefGoogle Scholar
  10. 10.
    Ragazzo TG, Paranagua-Vezozzo D, Lima FR, et al. Accuracy of transient elastography-FibroScan®, acoustic radiation force impulse (ARFI) imaging, the enhanced liver fibrosis (ELF) test, APRI, and the FIB-4 index compared with liver biopsy in patients with chronic hepatitis C. Clinics (Sao Paulo). 2017;72:516–25.CrossRefGoogle Scholar
  11. 11.
    Bucsics T, Grasl B, Ferlitsch A, et al. Point shear wave elastography for non-invasive assessment of liver fibrosis in patients with viral hepatitis. Ultrasound Med Biol. 2018;44:2578–86.CrossRefGoogle Scholar
  12. 12.
    Abozeid M, Alsebaey A, Abdelsameea E, et al. High efficacy of generic and brand direct acting antivirals in treatment of chronic hepatitis C. Int J Infect Dis. 2018;75:109–14.CrossRefGoogle Scholar
  13. 13.
    Das D, Pandya M. Recent advancement of direct-acting antiviral agents (DAAs) in hepatitis C therapy. Mini Rev Med Chem. 2018;18:584–96.CrossRefGoogle Scholar
  14. 14.
    Jiang HJ, Wang XX, Luo BF, et al. Direct antiviral agents upregulate natural killer cell potential activity in chronic hepatitis C patients. Clin Exp Med. 2019;19:299–308.CrossRefGoogle Scholar
  15. 15.
    Elsharkawy A, Alem SA, Fouad R, et al. Changes in liver stiffness measurements and fibrosis scores following sofosbuvir based treatment regimens without interferon. J Gastroenterol Hepatol. 2017;32:1624–30.CrossRefGoogle Scholar
  16. 16.
    Tag-Adeen M, Sabra AM, Akazawa Y, Ohnita K, Nakao K. Impact of hepatitis C virus genotype-4 eradication following direct acting antivirals on liver stiffness measurement. Hepat Med. 2017;9:45–53.CrossRefGoogle Scholar
  17. 17.
    Lu M, Li J, Zhang T, et al. Serum biomarkers indicate long-term reduction in liver fibrosis in patients with sustained virological response to treatment for HCV infection. Clin Gastroenterol Hepatol. 2016;14(1044–55):e3.Google Scholar
  18. 18.
    El-Akel W, El-Sayed MH, El Kassas M, et al. National treatment programme of hepatitis C in Egypt: hepatitis C virus model of care. J Viral Hepat. 2017;24:262–7.CrossRefGoogle Scholar
  19. 19.
    Ferraioli G, Filice C, Castera L, et al. WFUMB guidelines and recommendations for clinical use of ultrasound elastography: part 3: liver. Ultrasound Med Biol. 2015;41:1161–79.CrossRefGoogle Scholar
  20. 20.
    Mohamed R, Amin M, Omar H, Rabea MY, Abd Elazeem MA. Quantitative assessment of liver fibrosis in chronic viral hepatitis C patients using shear wave elastography with elastography point quantification feature. Egypt J Radiol Nucl Med. 2017;48:31–42.CrossRefGoogle Scholar
  21. 21.
    Suda T, Okawa O, Masaoka R, et al. Shear wave elastography in hepatitis C patients before and after antiviral therapy. World J Hepatol. 2017;9:64–8.CrossRefGoogle Scholar
  22. 22.
    Tada T, Kumada T, Toyoda H, et al. Improvement of liver stiffness in patients with hepatitis C virus infection who received direct-acting antiviral therapy and achieved sustained virological response. J Gastroenterol Hepatol. 2017;32:1982–8.CrossRefGoogle Scholar
  23. 23.
    Korda D, Lenard ZM, Gerlei Z, et al. Shear-wave elastography for the assessment of liver fibrosis in liver transplant recipients treated for hepatitis C virus recurrence. Eur J Gastroenterol Hepatol. 2018;30:27–32.CrossRefGoogle Scholar
  24. 24.
    Van der Meer AJ, Maan R, Veldt BJ, et al. Improvement of platelets after SVR among patients with chronic HCV infection and advanced hepatic fibrosis. J Gastroenterol Hepatol. 2016;31:1168–76.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Hepatology and Gastroenterology, National Liver InstituteMenoufia UniversityShebin El-KomEgypt
  2. 2.Department of Diagnostic and Interventional Radiology and Medical Imaging, National Liver InstituteMenoufia UniversityShebin El-KomEgypt
  3. 3.Department of Epidemiology and Preventive Medicine, National Liver InstituteMenoufia UniversityShebin El-KomEgypt

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