Introduction Chronic hepatitis C virus infection (HCV) is a common cause of cirrhosis and end stage liver disease. Treatment with Pegylated interferon (PEG-IFN) and ribavirin (RBV) results in sustained virological response (SVR) in approximately 60% of infected individuals. Increasing stage of fibrosis is known to be a key factor associated with non-response to treatment with PEG-IFN+RBV. Traditionally, fibrosis stage has been determined by liver biopsy, but this is invasive. Newer non-invasive methods of assessing fibrosis such as transient elastography (TE) are now available.
Aim To assess baseline liver stiffness measurement (LSM) assessed by TE as a predictor of SVR in HCV-infected subjects treated with PEG-IFN+RBV.
Method Retrospective review of outcomes of treatment in naïve patients treated with PEG-IFN+RBV for HCV between 7 January and 9 June. Post-transplant and co-infected patients were excluded. Patients who had valid LSM within 6 months of treatment were included in the TE analysis.
Results 168 patients (mean age 39±10, 70% male, 14% cirrhotic, 53% high viral load) received PEG-IFN+RBV for HCV in the study period. The overall SVR rate was 59% (50% for genotype [G] 1/4 and 70% for G2/3, p<0.001). The SVR rate was only 28% in cirrhotics (10% for G1/4 and 43% for G2/3). 87 patients had a pre-treatment TE (median LSM 6.6 KPa [3.3–73]).
LSM was significantly associated with treatment response to PEG-IFN (p=0.01), with the effect more pronounced in HCV G2/3 infection (p=0.001). The optimum cut-off to predict non-response to treatment was 11 KPa. 30 patients (16%) stopped treatment due to side-effects or non-compliance, including 1 death from pneumonitis.
Conclusion (1) LSM determined by transient elastography may be used as a non-invasive tool to predict treatment response in subjects infected with HCV.
(2) LSM >11 KPa could be used to identify patients who may have lower response rates and may benefit from longer treatment.
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