Endemic Medicine Department and Hepatology Unit, Faculty of Medicine, Cairo University , Cairo, Egypt .
J Interferon Cytokine Res. 2018 Mar;38(3):129-136. doi: 10.1089/jir.2017.0137. Epub 2018 Mar 12.
Hepatitis C virus (HCV) treatment is aiming to cure and prevent the development, progression of fibrosis, and related complications. Interferon-based therapy was claimed to reduce or even reverse fibrosis. Although direct-acting agents have a better cure rate, we still lack the knowledge of their effect on fibrosis regression. We aim to assess fibrosis regression in direct-acting agents compared with interferon-based treatment regimens in the treatment of chronic HCV patients. The 204 chronic HCV patients were divided into 3 groups; group 1(N = 68) received Peg-IFN and ribavirin, group 2 (N = 69) received sofosbuvir and ribavirin, and group 3 (N = 67) received Peg-IFN, ribavirin, and sofosbuvir. Fibrosis assessment was performed by transient elastography (TE), APRI and FIB 4, in the pretreatment and at least 3 months after end of treatment. Of these, 66.2% of the patients did not show significant fibrosis changes, 6.4% fibrosis progressed, and 27.5% of fibrosis regressed (P < 0.0001) by TE. Similar results were detected in the different treatment regimens with no statistically significant difference between the regimens. Fibrosis regression was detected in 43.3% of cirrhotic patients who achieved sustained virological response (SVR) and only in 27.4% with significant fibrosis. Significant improvement of posttreatment aspartate transaminase, alanine transaminase, and alpha fetoprotein as well as APRI and FIB 4 scores were detected. Fibrosis regression (TE, APRI and FIB 4) was detected with direct-acting agents and interferon-based therapy. Treated patients with significant fibrosis will benefit of fibrosis regression irrespective to their treatment response, whereas fibrosis regression was associated with SVR in cirrhotic patients.
丙型肝炎病毒 (HCV) 治疗的目的是治愈并预防纤维化的发展、进展和相关并发症。基于干扰素的治疗被认为可以减少甚至逆转纤维化。尽管直接作用药物的治愈率更高，但我们仍然缺乏它们对纤维化消退影响的知识。我们旨在评估直接作用药物与基于干扰素的治疗方案在治疗慢性 HCV 患者中的纤维化消退情况。204 例慢性 HCV 患者分为 3 组；第 1 组（N=68）接受 Peg-IFN 和利巴韦林，第 2 组（N=69）接受索非布韦和利巴韦林，第 3 组（N=67）接受 Peg-IFN、利巴韦林和索非布韦。纤维化评估通过瞬时弹性成像（TE）、APRI 和 FIB-4 在治疗前和治疗结束后至少 3 个月进行。其中，66.2%的患者没有出现显著的纤维化变化，6.4%的纤维化进展，27.5%的纤维化消退（P<0.0001）通过 TE 检测到。不同治疗方案中也检测到了类似的结果，方案之间无统计学差异。在获得持续病毒学应答（SVR）的肝硬化患者中，有 43.3%检测到纤维化消退，而在有显著纤维化的患者中，只有 27.4%检测到纤维化消退。治疗后天门冬氨酸转氨酶、丙氨酸转氨酶和甲胎蛋白以及 APRI 和 FIB-4 评分显著改善。通过直接作用药物和干扰素治疗检测到纤维化消退（TE、APRI 和 FIB-4）。无论治疗反应如何，有显著纤维化的治疗患者都将受益于纤维化消退，而纤维化消退与肝硬化患者的 SVR 相关。
