The evaluation of liver fibrosis regression in chronic hepatitis C patients after the treatment with direct-acting antiviral agents – A review of the literature

Journal of Mind and Medical Sciences Volume 6 | Issue 2 Article 5 2019 The evaluation of liver fibrosis regression in chronic hepatitis C patients after the treatment with directacting antiviral agents – A review of the literature Olga H. Orasan George Ciulei Sorina C. Coste Bianca A. Cibu Adela V. S Taut See next page for additional authors Follow this and additional works at: https://scholar.valpo.edu/jmms Part of the Endocrinology, Diabetes, and Metabolism Commons, Gastroenterology Commons, Hepatology Commons, and the Infectious Disease Commons Recommended Citation Orasan, Olga H.; Ciulei, George; Coste, Sorina C.; Cibu, Bianca A.; Taut, Adela V. S; Tarmure, Simina F.; Pfingstgraf, Iulia O.; Alexescu, Teodora G.; Popovici, Ionela E.; Mureșan, Flaviu; Ovidiu, Fabian; Negrean, Vasile; and Cozma, Angela (2019) "The evaluation of liver fibrosis regression in chronic hepatitis C patients after the treatment with direct-acting antiviral agents – A review of the literature," Journal of Mind and Medical Sciences: Vol. 6 : Iss. 2 , Article 5. DOI: 10.22543/7674.62.P210215 Available at: https://scholar.valpo.edu/jmms/vol6/iss2/5 This Review Article is brought to you for free and open access by ValpoScholar. It has been accepted for inclusion in Journal of Mind and Medical Sciences by an authorized administrator of ValpoScholar. For more information, please contact a ValpoScholar staff member at . The evaluation of liver fibrosis regression in chronic hepatitis C patients after the treatment with direct-acting antiviral agents – A review of the literature Authors Olga H. Orasan, George Ciulei, Sorina C. Coste, Bianca A. Cibu, Adela V. S Taut, Simina F. Tarmure, Iulia O. Pfingstgraf, Teodora G. Alexescu, Ionela E. Popovici, Flaviu Mureșan, Fabian Ovidiu, Vasile Negrean, and Angela Cozma This review article is available in Journal of Mind and Medical Sciences: https://scholar.valpo.edu/jmms/vol6/iss2/5 https://scholar.valpo.edu/jmms/ https://proscholar.org/jmms/ ISSN: 2392-7674 J Mind Med Sci. 2019; 6(2): 210-215 doi: 10.22543/7674.62.P210215 Received for publication: February 24, 2019 Accepted: April 24, 2019 Review The evaluation of liver fibrosis regression in chronic hepatitis C patients after the treatment with direct-acting antiviral agents – A review of the literature Olga H. Orasan1, George Ciulei2, Sorina C. Coste1, Bianca A. Cibu3, Adela V. Sitar Taut1, Simina F. Tarmure1, Iulia O. Pfingstgraf4, Teodora G. Alexescu1, Ionela E. Popovici1, Flaviu Mureșan5, Fabian Ovidiu5, Vasile Negrean1, Angela Cozma1 Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, 4th Medical Department, ClujNapoca, Romania; 2Clinical Hospital C.F. Cluj, Republicii no. 18, zip code 400015, Cluj-Napoca, Romania; 3 Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania; 4 Iuliu Hațieganu University of Medicine and Pharmacy, Department of Physiopathology, Cluj-Napoca, Romania; 5Iuliu Haţieganu University of Medicine and Pharmacy, 4th Surgical Department, Cluj-Napoca, Romania 1 Abstract The second-generation of direct-acting antiviral agents are the current treatment for chronic viral hepatitis C infection. To evaluate the regression of liver fibrosis in patients receiving this therapy, liver biopsy remains the most accurate method, but the invasiveness of this procedure is its major drawback. Different non-invasive tests have been used to study changes in the stage of liver fibrosis in patients with chronic viral hepatitis treated with the second-generation of direct-acting antiviral agents: liver stiffness measurements (with transient elastography or acoustic radiation force impulse elastography) or different scores that use serum markers to calculate a fibrosis score. We prepared a literature review of the available data regarding the long-term evolution of liver fibrosis after the treatment with direct-acting antiviral agents for chronic viral hepatitis C. Keywords  Highlights ✓ Transient elastography is the routine investigation for liver fibrosis monitoring in patients with chronic viral hepatitis C treated with direct acting antiviral agents. chronic viral hepatitis C, direct-acting antiviral agents, liver fibrosis ✓ The APRI and FIB-4 scores registered the highest decrease between the baseline and the end of the treatment in patients with chronic viral hepatitis C treated with direct acting antiviral agents. To cite this article: Orasan OH, Ciulei G, Coste SC, Cibu BA, Taut AVS, Tarmure SF, Pfingstgraf IO, Alexescu TG, Popovici IE, Mureșan F, Ovidiu F, Negrean V, Cozma A. The evaluation of liver fibrosis regression in chronic hepatitis C patients after the treatment with directacting antiviral agents – A review of the literature. J Mind Med Sci. 2019; 6(2): 210-215. DOI: 10.22543/7674.62.P210215 *Corresponding author: George Ciulei, Clinical Hospital C.F. Cluj, Republicii no. 18, zip code 400015, ClujNapoca, Romania E-mail: Olga Hilda Orasan et al. Introduction The main objective in treating chronic viral hepatitis C (CHC) with the second-generation of direct-acting antiviral agents (DAAs) is to achieve a sustained virologic response (SVR). Reversing liver fibrosis in previously infected patients is a secondary goal, since achieving viral clearance does not reverse all the liver damage. DAAs do not have an anti-fibrotic effect (1). In patients who achieved SVR with interferon therapy (the previous standard of care in CHC), liver fibrosis regression was measured in 42% of the cases, while 53.1% of the patients did not have a significant change in the liver fibrosis stage, and fibrosis progression was reported in 4.6% of the patients (2). In order to measure liver fibrosis, besides the gold standard of liver biopsy, various fibrosis scores calculated from routine laboratory tests have been developed and validated in recent years. These scores have numerous advantages, as they are neither invasive procedures nor expensive investigations. The aim of this article is to assess the changes that occur in liver fibrosis after SVR is achieved with DAAs, measured through liver biopsy and different non-invasive tests: transient elastography (TE), acoustic radiation force impulse elastography (ARFI), fibrosis-4 score (FIB-4), aspartate aminotransferaseplatelet ratio index (APRI), and hyaluronic acid (HA). Discussions Transient Elastography (TE) TE represents a non-invasive method of liver stiffness (LS) measurement which is used for fibrosis screening in various hepatic disorders as an alternative to liver biopsy (3). TE is routinely performed for liver fibrosis assessment prior to DAA therapy and also as a follow-up after achieving SVR (4-6). A cohort study including adults with CHC who received DAA-based therapies reports a regression of >30% in LS measured by TE 12 months after the end of treatment (EOT) (7). Fibrosis regression was demonstrated in another study including patients with advanced fibrosis (F3-F4), wh (...truncated)