Serum Biomarkers Indicate Long-term Reduction in Liver Fibrosis in Patients With Sustained Virological Response to Treatment for HCV Infection

Abstract

Background & aims: Sustained virological response (SVR) to antiviral therapy for hepatitis C virus (HCV) correlates with changes in biochemical measures of liver function. However, little is known about the long-term effects of SVR on liver fibrosis. We investigated the effects of HCV therapy on fibrosis, based on the Fibrosis-4 (FIB4) score, over a 10-year period.

Methods: We collected data from participants in the Chronic Hepatitis Cohort Study-a large observational multicenter study of patients with hepatitis at 4 US health systems-from January 1, 2006, through December 31, 2013. We calculated patients' FIB4 score and the aminotransferase-to-platelet ratio index (APRI) score over a 10-year period. Of 4731 patients with HCV infection, 1657 (35%) were treated and 755 (46%) of these patients achieved SVR.

Results: In propensity score-adjusted analyses, we observed significant longitudinal changes in FIB4 score that varied with treatment and response to treatment. In patients achieving SVR, FIB4 scores decreased sharply, remaining significantly lower over the 10-year period than in untreated patients or patients with treatment failure (P < .001). In independent analyses, men and patients with HCV genotype 1 or 3 infections had higher FIB4 scores than women or patients with HCV genotype 2 infections (P < .01 for both). Findings were similar in a sensitivity analysis that substituted the APRI as the marker of fibrosis instead of the FIB4 score.

Conclusions: SVR to HCV treatment appears to induce long-term regression of fibrosis based on FIB4 scores collected over 10 years from a large observational study of US hepatitis patients. Patients receiving no treatment or with treatment failure had progressive increases in FIB4 scores.

Keywords: CHeCS; Fibrosis Progression; Growth Curve Analysis of Trajectory; Outcome.

Figure 1

Four individual trajectories of _logFIB4 across 10 years of follow-up evaluation. Data were smoothed by the B-spline method (thick lines).

Figure 2

Average observed (top) and predicted (bottom) _logFIB4 from an unadjusted model with 95% confidence bands (shaded) over 10 years by treatment group. (A) Treatment failure and (B) untreated patients were compared at each time interval. *Significant difference between treatment failure and untreated patients at a specific time interval (P < .05). The number of patients at each time point is noted at the bottom.

Figure 3

Average observed (top) and predicted (bottom) _logAPRI with 95% confidence bands (shaded) over 41 intervals of 90 days by group. Treatment failure and untreated patients were compared at each time interval. *Significant difference between treatment failure and untreated patients at a specific time interval (P < .05). The number of patients at each time point is noted at the bottom.

Figure 4

Predicted average trajectories of _logFIB4 over 10 years by group (baseline FIB4, HCV GT, sex, and race) for patients 40 years or younger vs older than 60 years. Thick lines, GT 1 or 3 patients; thin lines, GT 2 patients; solid lines, women; dashed lines, men; black lines, black patients; gray lines, white patients. Lines are stratified by baseline FIB4 levels (top, >1.81; bottom, ≤1.81). The expected trajectory for black female GT 1 patients overlaps with the trajectory for white male GT 2 patients.