Fibrosis Evaluation by Transient Elastography in Patients With Long-Term Sustained HCV Clearance

Background: reversibility of advanced fibrosis after hcv-clearance is an important goal of therapy. objectives: measuring liver stiffness (ls) by transient elastography (te) might be helpful in this setting. patients and methods: we evaluated 104 patients with biopsy-proven chronic hepatitis c (chc) and sustained virological response (svr) after peg-interferon (ifn) plus ribavirin since at least 18 months. hcv-eradication was confirmed searching for serum hcv-rna (tma® sensitivity > 5-10 iu/ml). data from literature reported the best ls cut-off values for different stages of liver fibrosis were 7.1 kpa for metavir stage 2 (f2), 9.5 kpa for f3 and 12.5 for cirrhosis (f4). results: te was not reliable in four svr obese patients. metavir-stage of biopsy was f0-1 in 28, f2 in 47, f3 in 17 and f4 in eight patients. the median interval elapsed since achieving svr was 36 months (range: 18-77, sd :18). stratifying patients according to the histological stage assessed before treatment, a clear-cut gradient of ls values was observed from f0-1: median: 3.8 kpa (range: 3.5-4.9) to f2: 4.6 kpa (3.8-6.0), f3: 6.2 kpa (4.8-8.6) and f4: 8.4 kpa (6.2-9.2) (p = 0.001). overall, 86 patients had lower values of ls than the expected ls values according to metavirstage. at multivariate logistic analysis γ-gt and histological steatosis were independently associated with persistence of higher values of ls. conclusion: long term responders to ifn-based therapies have lower ls values than those who are untreated and still viraemic. high levels of γ-gt and liver steatosis, all markers of insulin resistance, may hamper reduction of liver stiffness after hcv-clearance.