Longitudinal assessment of liver stiffness in patients undergoing antiviral treatment for hepatitis C

Background and aims: Transient elastography has been suggested as a possible tool for the non-invasive diagnosis of fibrosis in HCV patients. The aim of this study was to evaluate liver stiffness before antiviral therapy, at the end and after 3 years of follow-up and its role as a possible predictive factor of sustained virological response (SVR). Methods: Liver stiffness was measured before treatment, at the end, and after 3 years of follow-up in 55 HCV patients (32 men and 23 women, age 51.82 ± 11.41 years) treated with peginterferon and ribavirin for either 48 (genotypes 1 and 4) or 24 weeks (genotypes 2 and 3). Results: In virological null responders (12 patients, 21.8%), stiffness values before treatment did not differ from those observed at the end of both therapy or follow-up (9.71±4.26, 10.11±4.68, and 10.19±3.43 kPa, respectively). SVR (30 patients, 54.5%) had mean stiffness values before treatment (10.09±6.85 kPa) which did not differ from those at the end of treatment (8.68±6.38 kPa, p= 0.062), while a significant decrease was observed after three years of follow-up (6.76±4.58, p=0.0141 vs. baseline). In relapsers (7 patients, 12.7%), stiffness values before treatment did not differ from those observed at the end of therapy or follow-up (15.16±8.20, 13.73±7.72, 16.86±10.00kPa, respectively). Pre-treatment stiffness values >12 kPa were significantly associated with no sustained virological response (p< 0.025) with a relative risk of 2.35 (95% CI 1.21 - 4.57) and an attributable risk of 26%. Conclusions: In HCV patients, liver stiffness may be useful to assess the long-term response to treatment. Evaluation of pre-treatment liver stiffness as predictor of SVR may provide an additional tool for patient selection, although it needs to be confirmed in more extensive cohorts.