A recent study showed improvements in measures of liver fibrosis at 12 months after treatment of Hepatitis C in Egyptian adolescents (DM Fahmy et al. J Pediatr 2021; 231: 110-116. Changes in Liver Stiffness and Noninvasive Fibrosis Scores in Egyptian Adolescents Successfully Treated with Ledipasvir-Sofosbuvir for Chronic Hepatitis C Virus Infection).
Methods: N=85. Liver stiffness measurement (LSM), by vibration-controlled transient elastography and noninvasive fibrosis scores (Firbosis-4, aspartate aminotransferase-platelet ratio index), were obtained before and 12 months after eradication with ledipasvir-sofosbuvir.
- Overall, median baseline LSM was 5.8 (IQR, 4.2-6.5) and at follow-up 5.1 kPa (IQR, 4-6 kPa) (P = .045)
- 16 patients (19%) experienced regression, and 46 (54%) nonprogression of LSM
- The median baseline FIB-4 and aspartate aminotransferase-platelet ratio index scores were 0.34 (IQR, 0.22-0.47) and 0.35 (0.24-0.57), and at follow-up 0.3 (IQR, 0.22-0.34) and 0.2 (0.18-2.8) (P < .001, <.001), respectively
Limitations: In Egypt, HCV genotype 4 is predominant; thus, findings could be different with other HCV genotypes. In addition, the ‘gold’ standard in assessing fibrosis remains a liver biopsy.
In many liver conditions, effective therapy has been associated with histologic improvement/regression. So, while the findings in this study are expected, it is still nice to see more evidence of this outcome.
My take: This study supports the notion that elimination of HCV is associated with either regression or non-progression of liver fibrosis. Treatment prior to extensive liver damage is likely both effective and cost-effective.
Related blog posts:
- The Best Time to Treat Children with Hepatitis C and Cost Considerations
- Online Aspen Webinar (Part 4 -Hepatitis C 2020)
- Medical Progress: Toward Hepatitis C Elimination (2020 Pediatric Treatment Algorithms)
- Hepatitis C in 2020: NASPGHAN Position Paper
- ‘Crushing it:” Practice Guidance for Hepatitis C
- Resolution: Eradication of Hepatitis C
- Pediatric HCV Guidelines
- “Crushing it:” Two More Pediatric Hepatitis C Trials
- Hepatitis C Infections Increasing -Tied to Opioid Crisis
- Hepatitis C Cure: Too Late for Many | gutsandgrowth