Changing of non-invasive fibrosis index values in hepatitis C patients treated with direct-acting antiviral agents.

INTRODUCTION: Hepatitis C virus (HCV) infection, which may lead to cirrhosis and hepatocellular carcinoma, is a major cause of chronic liver disease worldwide. Histological staging of liver fibrosis is essential for treatment decision-making and prognostication in patients with chronic HCV infection. DAAs (direct-acting antiviral agents) was known to reduce fibrosis. Owing to the invasive nature of liver biopsy, many noninvasive fibrosis indices have been developed to assess the stage of liver fibrosis. Among these indices, the aspartate aminotransferase (AST)/platelet ratio index (APRI), FIB-4 index, AST/alanin aminotransferase (ALT) ratio are commonly used. The present study investigated the temporal effect of DAAs on the noninvasive index values of patients with chronic HCV infection at baseline, week 4, month 3, month 6 and month 12. METHODS: The data of 88 chronic HCV infection who received a complete course of DAA therapy, between 2015 to 2018 were enrolled in this retrospective analysis. Inclusion criteria were as follows: age =18 years, presence of the serum anti-hepatitis C virus (HCV) antibody for >6 months and detectable HCV RNA, and completion of DAA therapy. Demographic, laboratory characteristics were compared. Changes in APRI, FIB-4 and AST/ALT index were compared with Willcoxon signed rank test. SPSS 22 computer program was used for statistical evaluation.. RESULTS: A total of 88 patients were enrolled retrospectively; their median age was 59 (23-80) years, and 46 (52,2%) of them were men. The median follow-up time was 28.2 month. The baseline median AST, ALT and total bilirubin levels were 55 (19-247) U/L, 56 (15-178) U/L, and 0.9 (0.3-3.3) mg/dL, respectively. The median platelet count was 175 (66-360) × 109/L. Furthermore, 21 (23.8%) patients had liver cirrhosis. Eighty-five (96.5%) patients received diagnoses of HCV genotype (GT) 1 infections. The baseline median APRI value was 1.01 (0.15-6.18), and the median FIB-4 value was 3.26 (0.34-12.01). In patients who received DAA therapy, the median APRI and FIB-4 values decreased from week 4 until month 12 (Figure 1). The median APRI value decreased from 1.01 at baseline to 0.44, 0.39, 0.39, and 0.38 at week 4, month 3, month 6 and month 12 respectively (all P<0.001). The median FIB-4 value decreased from 3.26 at baseline to 2.35, 2.27, 2.27, and 2.17 at week 4, month 3, month 6 and month 12, respectively (all P<0.001). DISCUSSION: Both the APRI, FIB-4 and AST/ALT index exhibited a strong correlation with liver fibrosis stage before antiviral therapy. Noninvasive fibrosis indices, namely APRI, FIB-4, AST/ALT exhibited a rapid and sustained decline from week 4 until month 12 in patients with chronic HCV infection. Despite the rapid decline in APRI, FIB-4, AST/ALT values might primarily result from reduction in necroinflammation, In the follow-up after DAA treatment, these tests may be helpfull. [ABSTRACT FROM AUTHOR]