Prospective non-invasive follow-up of liver fibrosis in patients with chronic hepatitis C.

Background: Non-invasive methods for the assessment of liver fibrosis are accurate in staging chronic liver diseases before treatment.

Aim: To prospectively assess liver fibrosis in chronic hepatitis C (CHC) in patients treated vs untreated, using non-invasive methods.

Method: 224 patients with CHC were included in the study: 179 received antiviral treatment for 48 weeks, and 45 patients received no antiviral therapy. All patients underwent liver biopsy at baseline and were also evaluated by simple biological scores (APRI, HAPRI, Forns, Bonacini, Lok) and transient elastography (TE). The progression of fibrosis was non-invasively assessed over a period of 72 weeks.

Results: Fibrosis decreased significantly in patients who gained sustained virological response (SVR). A significant decrease of fibrosis was also observed in all treated patients, irrespective of SVR when using APRI, HAPRI and Bonacini scores (p=0.001, 0.009 and 0.02). Untreated patients yielded constant values of fibrosis or a slight increase in follow-up. Patients with Lok score and stiffness predictive for cirrhosis had a decreasing trend of fibrosis (p=0.03 for Lok and 0.05 for TE), but persisting in the cirrhosis domain. Of the non responders, those who gained biological response demonstrated improvement of fibrosis assessed by APRI and TE.

Conclusion: The prospective follow-up of liver fibrosis assessed by simple biological scores and TE in patients with CHC revealed a downstaging of fibrosis in treated patients and especially in those who gained SVR.