Decline of liver stiffness in patients with HCV under DAA therapy is associated with decrease of inflammation markers

Background In patients with chronic hepatitis C (HCV) infection a fast decline of liver stiffness in non-invasive fibrosis measurement was described, even within the treatment period of therapy with direct-acting antivirals (DAA). Aim of this study was to evaluate the influence of inflammation on this in HCV patients under DAA therapy.

Methods We prospectively investigated change of liver stiffness by sonographic acoustic radiation force impulse (ARFI) at treatment initiation (base line, BL) and 12 weeks after end of therapy (SVR12) in 217 patients with HCV, treated with DAA therapy at our centre. In addition, demographic data, laboratory and virological parameters, cytokines and chemokines were obtained at these two time points, as well as at week 4 and at end of therapy.

Results ARFI values decreased from 1,86 m/s to 1,68 m/s (p = 0,01) which was most distinct in patients who had F4 fibrosis at BL levels (3,27 m/s to 2,37 m/s; p < 0,001). Initial elevated values of GOT and GPT, APRI score, FIB4 score, ferritin and IgG declined significantly (p < 0,001) under therapy but did not show any significant positive correlation (r < 0,1) with ARFI values. Albumin (p < 0,001) and thrombocyte count (p = 0,007) showed an increase and INR a decrease (p = 0,003; not in cirrhotic or F4 patients) under therapy without correlation to ARFI values.

The cytokines IL1α (p = 0,026), INFy (only in F4 fibrosis p = 0,043) showed an increase; TNFα (p = 0,031), IFNα2 (p = 0,036), IL10 (p = 0,005) and IP10 (p < 0,001) decreased under DAA therapy. Changes of TNFα (r = 0,54; p = 0,037) and IL10 (F1-F3 fibrosis, r = 0,32; p = 0,03) showed correlation with changes of ARFI values.

Conclusion In conclusion, our data demonstrates that ARFI values, fibrosis scores, systemic inflammation parameters and parameters of the liver function significantly improved under DAA therapy. In addition, we showed that not the fibrosis scores or platelet count correlate most with fast decline of ARFI values, but inflammation markers like the cytokines TNFα and IL10. ARFI measurement, commonly taken as a predictor of liver fibrosis, therefore had more correlation with inflammation markers than it had with markers of fibrosis.

Publication History

Article published online:
04 January 2021