Original Article
Sustained Improvements in Markers of Liver Disease Severity After Hepatitis C Treatment

https://doi.org/10.1016/j.jceh.2019.09.001Get rights and content

Background & aims

Although serological markers of disease severity improve after hepatitis C virus (HCV) treatment, it is unclear if all patients experience sustained improvement. We aim to evaluate longitudinal changes in aspartate (AST), alanine (ALT) aminotransferase, platelet count (PLT), and fibrosis-4 (FIB-4) after HCV treatment.

Methods

All adult chronic HCV patients who received antiviral therapy from January 2011 to February 2017 at four large urban hospital systems were evaluated to assess changes in AST, ALT, PLT, and FIB-4 from pre-treatment to post-treatment annually up to 4 years after HCV therapy. Comparisons used Student's t-test and analysis of variance, and were stratified by sex, race, ethnicity, age, body mass index (BMI), and diabetes mellitus.

Results

Among 2691 patients (62.2% men, 76.9% aged 45–65 years, 56.5% white), all markers of disease severity demonstrated sustained improvements from pre-treatment to 4 years post-treatment (AST 53 U/L to 27.5 U/L, ALT 53 U/L to 29 U/L, PLT 168 × 103 to 176 × 103, FIB-4 2.51 to 1.68). However, Hispanics and patients with BMI >30 kg/m2 experienced rebound increases in AST, ALT, and FIB-4 at 4 years post-treatment after experiencing initial improvements in these serological markers in the first-year post-treatment. Sustained improvements in PLT were observed in all groups, including Hispanics and patients with BMI >30 kg/m2.

Conclusion

HCV treatment in a large community-based cohort demonstrated sustained improvements in AST, ALT, PLT, and FIB-4. Rebound increases in AST, ALT, and FIB-4 observed in Hispanics and those with BMI >30 kg/m2 may reflect persisting nonalcoholic fatty liver disease.

Section snippets

Study Population

All adult chronic HCV patients who received HCV antiviral therapies from January 1, 2011 to February 28, 2017 at four large urban hospital systems in California, Louisiana, Texas, and Virginia were included. Chronic HCV patients were identified via electronic health record (EHR) query using ICD-9 and ICD-10 codes (070.70, 070.71, 070.41, 070.44, 070.54, 070.6, V02.62, B19.2, or B18.2) as well as manual review of the medical records. Additional confirmation of chronic HCV status was performed

Patient Characteristics

Among 2691 patients who received HCV therapy during the study period, most patients were men (62.2%, n = 1674), aged 45–65 years (76.9%, n = 2070), non-Hispanic ethnicity (93.2%, n = 2508), and white race (56.5%, n = 1519) (Table 1). Most patients were HCV genotype 1 (68.0%) and few patients had liver-related complications at the time of treatment initiation (9.8% with concurrent HCC, 11.0% with hepatitis B virus co-infection, 7.5% with concurrent NAFLD, 12.6% with ascites, 10.6% with hepatic

Discussion

Among our multicentered cohort of 2691 patients who were successfully treated for chronic HCV, overall sustained improvements were observed in AST, ALT, PLT, and FIB-4 scores. Few studies have specifically evaluated longitudinal changes in serological makers after HCV treatment in the DAA era. Our study also provides interesting data on disparate changes in these serological markers in different subgroups.

Although our race/ethnicity-specific analyses demonstrated similar improvements in

Disclosures

RJW receives research funding from Gilead Sciences and Abbvie, has served as a consultant and member of the advisory board for Gilead Sciences, and serves on the speaker's bureau for Gilead Sciences, Salix, and Bayer. RJW is also funded by an AASLD Foundational Clinical and Translational Research Award in Liver Diseases.

MKJ receives research funding from Gilead Sciences, Merck, Janssen, and GlaxoSmithKline / ViiV Healthcare and has served as an advisor for GlaxoSmithKline.

MLS receives grant

Authors' contribution

RJW and MT—study concept and design; RJW, MKJ, GT, MLS, OK, CC, and MT—acquisition of data; RJW, MKJ, GT, MLS, OK, CC, and MT—analysis and interpretation of data; OK and MT—statistical analysis; MKJ and MT—drafting of the manuscript; RJW, MKJ, GT, MLS, OK, CC, and MT—critical revision of the manuscript for important intellectual content; RJW and MT—study supervision; RJW and MT had full access to all the data in the study and take responsibility for the integrity of the data and accuracy of the

Conflicts of interest

The authors have none to declare.

Funding/Support

This study was supported by an investigator-initiated study research grant from Gilead Sciences. Robert Wong is supported by an AASLD Foundation Clinical and Translational Research Award in Liver Diseases.

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