Efficacy of direct-acting antiviral agents in treatment of chronic hepatitis C and its effect on liver stiffness and aspartate aminotransferase-to-platelet ratio index

Objective To investigate the real-world viral response of chronic hepatitis C( CHC) patients receiving direct-acting antiviral agent( DAA) treatment and its effect on liver stiffness measurement( LSM) and aspartate aminotransferase-to-platelet ratio index( APRI). Methods The CHC patients who were consecutively admitted to Tianjin Third Central Hospital from April 1,2018 to November30,2018 and received DAA treatment were enrolled,and all patients were treated with DAA( without interferon) for 12-24 weeks. Virologic response was evaluated at week 12 after treatment ended,and the changes of LSM and APRI from baseline to week 12 after treatment were compared. The Wilcoxon rank-sum test was used for comparison of continuous data between two groups. Results A total of 212 CHC patients were enrolled in our study,among whom 35. 4% had liver cirrhosis,and the patients with genotype 1 b,2 a,3 a,or 6 a accounted for75. 0%,18. 4%,4. 2%,and 2. 4%,respectively. Of all patients,174 completed the course of DAA treatment and the 12-week follow-up,and among these patients,98. 3% achieved sustained virologic response( SVR) at the end of DAA treatment and 95. 4% acquired SVR at week 12 after the treatment ended. Among the patients with genotype 1 b,2 a,3 a,or 6 a,96. 3%,93. 1%,80. 0%,and 100%,respectively,achieved SVR at week 12 after the treatment ended. There were significant reductions in LSM [9. 8( 6. 9-16. 3) kPa vs 11. 4( 7. 7-19. 1) kPa,Z =-2. 5,P = 0. 012]and APRI [0. 34( 0. 25-0. 64) vs 0. 76( 0. 56-2. 25),Z =-6. 6,P < 0. 001]from baseline to week 12 after the treatment ended. The patients were divided into groups according to the presence or absence of liver cirrhosis at baseline,and the results showed that from baseline to week 12 after treatment ended,the non-liver cirrhosis group had a significant reduction in LSM[7. 6( 6. 6-10. 7) k Pa vs 8. 8( 7. 2-13. 0) kPa,Z =-2. 7,P = 0. 007],while the liver cirrhosis group had no significant change in LSM [17. 4( 12. 7-22. 1) kPa vs 19. 8( 12. 8-24. 9) kPa,Z =-1. 4,P = 0. 152]. There was a significant reduction in APRI from baseline to week 12 after treatment ended in the liver cirrhosis group [0. 73( 0. 52-1. 34) vs 1. 37( 0. 80-2. 11),Z =-3. 4,P <0. 001] and the non-liver cirrhosis group [0. 29( 0. 21-0. 36) vs 0. 54( 0. 31-0. 95),Z =-6. 8,P < 0. 001]. Conclusion In this real-world study,CHC patients treated with DAA achieve a high overall virological response rate,with significant improvements in LSM and APRI at week 12 after treatment ends.