Improvement in Liver Stiffness in Pediatric Patients with Hepatitis C Virus after Treatment with Direct Acting Antivirals

J Pediatr. 2021 Jun:233:126-131. doi: 10.1016/j.jpeds.2021.02.012. Epub 2021 Feb 9.

Abstract

Objectives: To assess the degree of liver stiffness using transient elastography in Egyptian children infected with hepatitis C virus (HCV) at baseline and 1 year after achievement of sustained virologic response (SVR) with direct acting antivirals.

Study design: This prospective study included children infected with HCV who received treatment with sofosbuvir/ledipasvir and achieved SVR. At baseline and 1 year after achievement of SVR, the extent of hepatic fibrosis was assessed by transient elastography using FibroScan to measure liver stiffness, in addition to noninvasive markers including aspartate aminotransferase/platelet ratio index (APRI) and fibrosis-4 (FIB-4) index.

Results: The study included 23 cases that had variable degrees of fibrosis at baseline; their ages ranged between 10 and 18 years. At baseline, 13 patients had F1; 3 patients had F1-F2; 1 patient had F2; 3 patients had F3; 2 had F3-F4; and 2 patients with F4. One year after achievement of SVR, there was a statistically significant improvement in liver stiffness, APRI, and FIB-4 index (P = .03, <.001, .02, respectively). In 13 patients (56.5%), the liver stiffness improved; in 7 patients, it was stationary; and the remaining 3 patients showed mild increase in liver stiffness that was, however, associated with improvement in APRI and FIB-4 index. Comorbid conditions and previous treatment with interferon were not associated with increased liver stiffness 1 year after SVR.

Conclusions: Egyptian children infected with HCV genotype 4 achieved significant regression in liver stiffness after treatment with direct acting antivirals.

Keywords: DDAs; children; fibroscan; fibrosis; hepatitis C.

MeSH terms

  • Adolescent
  • Antiviral Agents / therapeutic use*
  • Aspartate Aminotransferases / blood
  • Benzimidazoles / therapeutic use
  • Child
  • Elasticity Imaging Techniques*
  • Female
  • Fluorenes / therapeutic use
  • Genotype
  • Hepatitis C / genetics
  • Hepatitis C, Chronic / drug therapy*
  • Humans
  • Liver Cirrhosis / classification
  • Liver Cirrhosis / diagnostic imaging*
  • Male
  • Prospective Studies
  • Sofosbuvir / therapeutic use

Substances

  • Antiviral Agents
  • Benzimidazoles
  • Fluorenes
  • ledipasvir
  • Aspartate Aminotransferases
  • Sofosbuvir