Author/Authors :
Calvaruso, Vincenza University of Palermo - Gastroenterologia Epatologia, Dipartimento Biomedico di Medicina Interna e Specialistica (Di Bi M I S ), Italy , Marco, Vito Di University of Palermo - Gastroenterologia Epatologia, Dipartimento Biomedico di Medicina Interna e Specialistica (Di Bi M I S ), Italy , Ferraro, Donatella University of Palermo - Dipartimento di Igiene G D’Alessandro, Italy , Petta, Salvatore University of Palermo - Gastroenterologia Epatologia, Dipartimento Biomedico di Medicina Interna e Specialistica (Di Bi M I S ), Italy , Calì, Anna University of Palermo - Gastroenterologia Epatologia, Dipartimento Biomedico di Medicina Interna e Specialistica (Di Bi M I S ), Italy , Bavetta, Maria Grazia University of Palermo - Gastroenterologia Epatologia, Dipartimento Biomedico di Medicina Interna e Specialistica (Di Bi M I S ), Italy , Conte, Elisabetta University of Palermo - Gastroenterologia Epatologia, Dipartimento Biomedico di Medicina Interna e Specialistica (Di Bi M I S ), Italy , Almasio, Piero Luigi University of Palermo - Gastroenterologia Epatologia, Dipartimento Biomedico di Medicina Interna e Specialistica (Di Bi M I S ), Italy
Abstract :
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.
