CONCORDANCE OF NON-INVASIVE TESTS FOR LIVER FIBROSIS IN HCV PATIENTS PROPOSED FOR TREATMENT WITH DIRECT ACTING ANTIVIRALS

Abstract

With the introduction of direct acting antivirals in the therapeutic armamentarium of hepatitis C (HCV), policy makers have set criteria for treatment eligibility. In Romania, the combination of ombitasvir/paritaprevir/ritonavir and dasabuvir is reimbursed for F4 fibrosis on liver biopsy/Fibromax, or F3 with contraindication to interferon (IFN). Our aim was to assess treatment eligibility and discordance between serological, elastometric and imaging evaluation of fibrosis in a cohort of patients with HCV. We evaluated both newly diagnosed and previously known HCV patients with advanced fibrosis, from our database, during a period of 7 months, between November 1st, 2015 and May 31st, 2016. Clinical, biological, ultrasound, elastography and endoscopy data were collected. Altogether 146 patients were assessed for treatment eligibility. Among them, 61% were females, with a mean age of 60 ± 8 years. Regarding treatment status, 52.5 % were naive, 27.4% nonresponders, 17.81% relapsers and 2.74% intolerant to bitherapy. 54.8% had elevated alpha-fetoprotein and were checked by advanced imaging for exclusion of hepatocellular carcinoma (HCC) – of them, 8 were diagnosed with HCC. On ultrasound, almost 1/2 patients had dilated splenoportal axis and at endoscopy 42% had esophageal varices. Transient elastography (Fibroscan) was done in 88/146 patients: 82.95% were F4, 1.14% F3-F4, 9.09% F3 and 6.82% <F3. 125/146 underwent biomarker evaluation of fibrosis: 78.4% were F4, 3.2% F3-F4, 11.2% F3 and 7.2% <F3; 20% of patients had significant steatosis (S≥2). On discordance analysis of the fibrosis evaluation methods, 7 cases had low fibrosis on serum markers but advanced fibrosis on elastography. All had genotype 1b, except for 2 patients (one G2 and the other G3) and the mean viremic load was 1,812,994 UI/ ml. Reasons for ineligibility were: HCC (8/146), decompensation (9/146) and <F4 fibrosis without arguments for cirrhosis or contraindication for interferon treatment.

Keywords

• chronic hcv infection
• liver fibrosis
• direct acting antivirals