Longitudinal assessment of liver stiffness by transient elastography for chronic hepatitis C patients

Abstract

Background: Liver fibrosis is a common pathway of liver injury and is a feature of most chronic liver diseases. Fibrosis progression varies markedly in patients with hepatitis C virus (HCV). Liver stiffness has been recommended as a parameter of fibrosis progression/regression in patients with HCV.

Aim: To investigate changes in liver stiffness measured by transient elastography (TE) in a large, racially diverse cohort of United States patients with chronic hepatitis C (CHC).

Methods: We evaluated the differences in liver stiffness between patients treated with direct-acting antiviral (DAA) therapy and untreated patients. Patients had ≥ 2 TE measurements and no prior DAA exposure. We used linear regression to measure the change in liver stiffness between first and last TE in response to treatment, controlling for age, sex, race, diabetes, smoking status, human immunodeficiency virus status, baseline alanine aminotransferase, and baseline liver stiffness. Separate regression models analyzed the change in liver stiffness as measured by kPa, stratified by cirrhosis status.

Results: Of 813 patients, 419 (52%) initiated DAA treatment. Baseline liver stiffness was 12 kPa in 127 (16%). Median time between first and last TE was 11.7 and 12.7 mo among treated and untreated patients, respectively. There was no significant change in liver stiffness observed over time in either the group initiating DAA treatment (0.016 kPa/month; CI: -0.051, 0.084) or in the untreated group (0.001 kPa/mo; CI: -0.090, 0.092), controlling for covariates. A higher baseline kPa score was independently associated with decreased liver stiffness.

Conclusion: DAA treatment was not associated with a differential change in liver stiffness over time in patients with CHC compared to untreated patients.

Keywords: Chronic hepatitis C; Cirrhosis; Direct-acting antiviral therapy; Liver stiffness; Transient elastography.

Figure 1

Change in liver stiffness between first and last transient elastography measurement in patients with chronic hepatitis C infection. Scatter plot illustrating the difference in liver stiffness (kPa) between the first and last transient elastography measurement for patients who were treated (n = 405) and not treated (n = 365) with direct-acting antiviral therapy for chronic hepatitis C infection during the study period. Circles correspond to values for individual patients. kPa: Kilopascals; TE: Transient elastography.