Department of Children's Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland.
Department of Pediatric Infectious Diseases, Regional Hospital of Infectious Diseases in Warsaw, 01-201 Warsaw, Poland.
Viruses. 2021 Jul 31;13(8):1518. doi: 10.3390/v13081518.
One-year outcomes after therapy with ledipasvir/sofosbuvir (LDV/SOF) in children with chronic hepatitis C (CHC) presenting with and without significant liver fibrosis were analyzed. We included patients aged 12-17 years treated with LDV/SOF, presenting with significant fibrosis (F ≥ 2 on the METAVIR scale) in transient elastography (TE) at the baseline and we compared the outcomes with that of patients without fibrosis. Patients were followed every 4 weeks during the treatment, at the end of the therapy, at week 12 posttreatment, and one year after the end of treatment. Liver fibrosis was established using noninvasive methods: TE, aspartate transaminase-to-platelet ratio index (APRI), and Fibrosis-4 index (FIB-4). There were four patients with significant fibrosis at baseline: one with a fibrosis score of F2 on the METAVIR scale, and three with cirrhosis (F4) at baseline. One year after the end of treatment, the hepatitis C viral load was undetectable in three of them. One patient was lost to follow-up after week 4. In two out of the four patients, a significant improvement and regression of liver fibrosis was observed (from stage F4 and F2 to F0-F1 on the METAVIR scale). In one patient, the liver stiffness measurement median increased 12 weeks after the end of the treatment and then decreased, but still correlated with stage F4. An improvement in the APRI was observed in all patients. In four patients without fibrosis, the treatment was effective and no progression of fibrosis was observed. A one-year observation of teenagers with CHC and significant fibrosis treated with LDV/SOF revealed that regression of liver fibrosis is possible, but not certain. Further observations in larger groups of patients are necessary to find predictors of liver fibrosis regression.
对伴有和不伴有显著肝纤维化的慢性丙型肝炎（CHC）儿童接受 ledipasvir/sofosbuvir（LDV/SOF）治疗一年后的结果进行了分析。我们纳入了年龄在 12-17 岁之间，在基线时采用瞬时弹性成像（TE）检测到显著纤维化（METAVIR 评分≥2 分）的患者，并将结果与无纤维化的患者进行了比较。患者在治疗期间每 4 周随访一次，治疗结束时、治疗结束后 12 周和治疗结束后一年。肝纤维化通过非侵入性方法确定：TE、天冬氨酸转氨酶与血小板比值指数（APRI）和 Fibrosis-4 指数（FIB-4）。基线时有 4 例患者有显著纤维化：1 例 METAVIR 评分 F2 分，3 例基线时肝硬化（F4）。治疗结束一年后，其中 3 例丙型肝炎病毒载量不可检测。1 例患者在第 4 周后失访。在这 4 例患者中，有 2 例观察到肝纤维化显著改善和消退（从 METAVIR 评分的 F4 和 F2 期到 F0-F1 期）。在 1 例患者中，治疗结束后 12 周肝硬度测量中位数增加，然后减少，但仍与 F4 期相关。所有患者的 APRI 均有所改善。在 4 例无纤维化的患者中，治疗有效，无纤维化进展。对接受 LDV/SOF 治疗的伴有显著纤维化的青少年 CHC 患者进行了为期一年的观察，结果表明肝纤维化的消退是可能的，但并非确定。需要对更大的患者群体进行进一步观察，以寻找肝纤维化消退的预测因素。
