A Long-term Clinical Study Of Virological And Hepatic Benefits Of Patients With Chronic Hepatitis C Virus Infected After DAA Treatment

Objective: To evaluate the virological response and long-term liver benefits of patients with chronic hepatitis C virus infection after DAA treatment at various time points.Methods: All the clinical data came from 223 cases of HCV patients who had underwent DAA treatment from January 1,2015 to February 28,2021 in the second affiliated hospital of Chongqing medical university.Results: 1.SVR: Among the patients with data at each time point,the SVR12 was 98.1%,the patients with the longest follow-up could reach SVR216,and the SVR was more than 93.3% in the patients with follow-up data at each time point.During the follow-up,a total of 5 patients developed hepatitis C virus recurrence,all of whom were HCV genotype 3 infected patients,4 patients with baseline cirrhosis,and 1 patient with baseline non-cirrhosis.2.Liver fibrosis: FIB-4 and APRI of patients in the cirrhosis group and non-cirrhosis group decreased from baseline in each follow-up period after treatment(P<0.001),and the decrease of FIB-4 and APRI among non-cirrhosis group from baseline to the end of treatment were more than that of the cirrhosis group,the difference being statistically significant(P <0.001).3.Improvement of liver biochemistry: the levels of ALT,AST,GGT and AKP in patients with cirrhosis and non-cirrhosis in each follow-up period after treatment were decreased compared with baseline(P<0.05).For patients in the cirrhosis group with abnormal baseline and comparable liver biochemistry data before and after treatment,the normalization rates of ALT,AST,GGT,and AKP were 90.5%(57/63),92%(69/75),94.3%(50/53),and 84.2%(16/19),respectively..For patients in the non-cirrhosis group with abnormal baseline and comparable liver biochemistry data before and after treatment,the normalization rate of ALT,AST,GGT,and AKP was 95.5%(71/74),90.8%(69/76),87.8%(43/49),and 85.7%(6/7),respectively.4.Incidence of HCC: In the 223 patients with follow-up data,the longest observation period of about 5 years,a total of 5patients developed HCC at 24,36,72,108,and 36 weeks after the end of treatment,respectively.All the 5 patients had baseline cirrhosis,including 1patient with HBV infection.All the 5 patients obtained and maintained SVR.By the end of observation,the longest SVR60,SVR60,SVR72,SVR108,and SVR36 were obtained.Patients with HCC had lower white blood cell(P =0.046),platelet(P =0.005),albumin(P =0.015),and higher total bilirubin(P =0.039),INR(P =0.044),FIB-4(P =0.002),and APRI(P=0.005)levels at baseline compared with patients without HCC after treatment.Since all patients with HCC after treatment had pre-treatment cirrhosis,there was no significant statistical difference when comparing baseline data between HCC group and non-HCC group in the cirrhosis population(P > 0.05).5.HCC recurrence: Among the 223 patients,there were 4 patients with baseline HCC,and 2 patients with HCC recurrence during the observation period after the end of treatment,which were 24 weeks and 144 weeks after the end of treatment,respectively.1 patient developed HCC progression at 12 weeks after the end of DAA treatment.6.HBV status: In this study,the co-infection rate of HBV/HCV was 13.2%(20/151),2 patients had started HBV antiviral therapy before DAA treatment,6 patients had received prophylactic anti-HBV therapy in addition to anti-HCV therapy,and the other 12 patients did not receive anti-HBV therapy.Except for 3 patients(2 who did not receive anti-HBV therapy and 1 who received both anti-HBV and HCV therapy),the remaining 17 patients were followed up for HBV DNA 1-5 times after the initiation of DAA therapy,and no HBV reactivation was observed after treatment.Up to 71.5%(108/151)of the patients had HBc Ab positivity.Of the 9 patients who developed HCC at baseline and after treatment,8patients had HBV status tests,Eight out of eight(100%)patients were HBc Ab positive.Among the 11 patients with no improvement in FIB-4after DAA treatment,8 patients had HBV status tests,7/8(87.5%)of the11 patients had HBc Ab positive.Conclusions: The use of DAA in the treatment of chronic hepatitis C resulted in a long-term sustained virological response with a high SVR rate.Treatment of chronic hepatitis C with DAA results in improvement in the degree of fibrosis,especially in non-cirrhosis patients.After DAA treatment,liver biochemistry of patients with cirrhosis and non-cirrhosis had a higher rate of normalization.Patients with baseline cirrhosis are likely to develop HCC even after DAA antiviral therapy.Patients with HCC have lower platelet and albumin levels at baseline,and higher levels of total bilirubin,INR,FIB-4,and APRI compared with patients without HCC after treatment.HBc Ab positivity may be associated with poorer outcomes in patients with HCV infection.