Dos Santos Deise Machado, Penteado Júlia Oliveira, Nader Maiba Mikhael, Basso Rossana Patrícia, da Silva Naylê Maria Oliveira, Quiche Lara Carolina Peixoto, Borges Mariana Penteado, Gehres Luiz Felipe Silveira, Hoffmann Tchurle, Rodrigues Leandro Farias, da Silva Júnior Flavio Manoel Rodrigues
Faculdade de Medicina, Universidade Federal do Rio Grande - FURG.
Laboratório de Testes Farmacológicos e Toxicológicos - LEFT, Instituto de Ciências Biológicas, Universidade Federal do Rio Grande.
Eur J Gastroenterol Hepatol. 2025 May 1;37(5):638-643. doi: 10.1097/MEG.0000000000002936. Epub 2025 Feb 6.
The aim of this study was to evaluate the degree of advanced fibrosis (F3/F4) using noninvasive methods [elastography, Fibrosis-4 (FIB4), and aspartate aminotransferase to platelet ratio index (APRI)] before and after treatment with new direct-acting antiviral agents (DAAs) in patients with hepatitis C virus (HCV), both in cases of co-infection (HCV/HIV) and single infection (HCV).
This is a longitudinal study involving patients with HCV who are co-infected with HIV, who initiated HCV treatment between a positive anti-HCV test for more than 6 months and detectable HCV RNA. The control group consisted of patients with HCV infection without HIV co-infection, who received treatment during the same period as the co-infected patients.
A total of 75 co-infected and 87 mono-infected HCV patients were eligible. Before treatment, elastography and FIB4 methods showed a strong agreement (0.73), while after treatment, the agreement was moderate (0.58). Between elastography and APRI, a strong agreement was observed before treatment (0.66) and fair/weak agreement after treatment (0.30). Both FIB4 and APRI showed perfect agreement at both time points with values above 0.9 (0.97 for pretreatment and 0.92 for posttreatment). The use of DAAs was associated with high rates of sustained virological response and reduction in fibrosis degrees in the posttreatment period, as assessed through biomarkers and hepatic elastography.
The utilization of biomarkers in clinical practice for assessing hepatic fibrosis is an essential tool. Thus, for an accurate evaluation of hepatic fibrosis, particularly after HCV treatment, the use of elastography, rather than biomarkers alone, is more appropriate.
本研究旨在评估丙型肝炎病毒（HCV）患者在接受新型直接作用抗病毒药物（DAA）治疗前后，采用非侵入性方法[弹性成像、纤维化-4（FIB4）和天冬氨酸转氨酶与血小板比值指数（APRI）]评估肝纤维化进展程度（F3/F4），包括合并感染（HCV/HIV）和单一感染（HCV）的情况。
这是一项纵向研究，纳入HCV合并HIV感染且抗-HCV检测阳性超过6个月且可检测到HCV RNA后开始HCV治疗的患者。对照组由同期接受治疗的无HIV合并感染的HCV感染患者组成。
共有75例合并感染和87例单一感染HCV的患者符合条件。治疗前，弹性成像和FIB4方法显示出高度一致性（0.73），而治疗后一致性为中等（0.58）。弹性成像和APRI之间，治疗前显示出高度一致性（0.66），治疗后一致性为中等/较弱（0.30）。FIB4和APRI在两个时间点的值均显示出完美一致性，均高于0.9（治疗前为0.97，治疗后为0.92）。通过生物标志物和肝脏弹性成像评估，DAA的使用与治疗后期较高的持续病毒学应答率和纤维化程度降低相关。
在临床实践中利用生物标志物评估肝纤维化是一项重要工具。因此，为准确评估肝纤维化，尤其是在HCV治疗后，使用弹性成像而非仅使用生物标志物更为合适。
