Dynamic change of metabolic dysfunction-associated steatotic liver disease in patients with hepatitis C virus infection after achieving sustained virologic response with direct-acting antivirals

Chen-Hua Liu; Yu-Ping Chang; Yu-Jen Fang; Pin-Nan Cheng; Chi-Yi Chen; Wei-Yu Kao; Chih-Lin Lin; Sheng-Shun Yang; Yu-Lueng Shih; Cheng-Yuan Peng; Ming-Chang Tsai; Shang-Chin Huang; Tung-Hung Su; Tai-Chung Tseng; Chun-Jen Liu; Pei-Jer Chen; Jia-Horng Kao

doi:10.1007/s00535-024-02101-2

Dynamic change of metabolic dysfunction-associated steatotic liver disease in patients with hepatitis C virus infection after achieving sustained virologic response with direct-acting antivirals

J Gastroenterol. 2024 Apr 13. doi: 10.1007/s00535-024-02101-2. Online ahead of print.

Authors

Chen-Hua Liu^#^{1

2

3}, Yu-Ping Chang^#¹, Yu-Jen Fang³, Pin-Nan Cheng⁴, Chi-Yi Chen⁵, Wei-Yu Kao^{6

7

8

9}, Chih-Lin Lin¹⁰, Sheng-Shun Yang^{11

12

13}, Yu-Lueng Shih¹⁴, Cheng-Yuan Peng^{15

16}, Ming-Chang Tsai^{17

18}, Shang-Chin Huang¹⁹, Tung-Hung Su^{1

2}, Tai-Chung Tseng^{1

2

20}, Chun-Jen Liu^{1

2

21}, Pei-Jer Chen^{1

2

21}, Jia-Horng Kao^{22

23

24

25}

Affiliations

¹ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
² Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan.
³ Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan.
⁴ Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
⁵ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan.
⁶ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
⁷ Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
⁸ TMU Research Center for Digestive Medicine, Taipei Medical University, Taipei, Taiwan.
⁹ Taipei Cancer Center, Taipei Medical University, Taipei, Taiwan.
¹⁰ Department of Gastroenterology, Taipei City Hospital, Ren-Ai Branch, Taipei, Taiwan.
¹¹ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
¹² School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
¹³ Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan.
¹⁴ Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
¹⁵ Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
¹⁶ School of Medicine, China Medical University, Taichung, Taiwan.
¹⁷ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
¹⁸ Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
¹⁹ Department of Internal Medicine, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan.
²⁰ Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan.
²¹ Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, 7 Chung-Shan South Road, Taipei, 10002, Taiwan.
²² Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. kaojh@ntu.edu.tw.
²³ Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan. kaojh@ntu.edu.tw.
²⁴ Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan. kaojh@ntu.edu.tw.
²⁵ Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, 7 Chung-Shan South Road, Taipei, 10002, Taiwan. kaojh@ntu.edu.tw.

^# Contributed equally.

PMID: 38613690
DOI: 10.1007/s00535-024-02101-2

Abstract

Background: Information on the dynamics of metabolic dysfunction-associated steatotic liver disease (MASLD) among hepatitis C virus patients achieving sustained virologic response (SVR₁₂) with direct-acting antivirals (DAAs) is limited.

Methods: We enrolled 1512 eligible participants in this prospective study. MASLD was defined by a controlled attenuation parameter (CAP) of ≥248 dB/m utilizing vibration-controlled transient elastography in conjunction with presence of ≥1 cardiometabolic risk factor. The distribution of MASLD and the changes in CAP were evaluated before treatment and at SVR₁₂. Forward stepwise logistic regression analyses were performed to determine factors significantly associated with the regression or emergence of MASLD.

Results: The prevalence of MASLD decreased from 45.0% before treatment to 36.1% at SVR₁₂. Among 681 participants with MASLD before treatment, 144 (21%) exhibited MASLD regression at SVR₁₂. Conversely, among 831 participants without MASLD before treatment, 9 (1.1%) developed MASLD at SVR₁₂. Absence of type 2 diabetes (T2D) [odds ratio (OR): 1.73, 95% confidence interval (CI): 1.13-2.65, p = 0.011], age > 50 years (OR: 1.73, 95% CI: 1.11-2.68, p = 0.015), and alanine transaminase (ALT) ≤ 2 times the upper limit of normal (ULN) (OR: 1.56; 95% CI: 1.03-2.37, p = 0.035) were associated with the regression of MASLD. Presence of T2D was associated with the emergence of MASLD (OR: 5.83, 95% CI: 1.51-22.56, p = 0.011).

Conclusions: The prevalence of MASLD decreased after achieving SVR₁₂ with DAAs. Patients with pre-existing T2D showed a diminished probability of MASLD regression and a heightened risk of MASLD emergence post-SVR₁₂.

Keywords: Controlled attenuation parameter; Direct-acting antiviral; Hepatitis C virus; Metabolic dysfunction-associated steatotic liver disease; Sustained virologic response.

Abstract

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