Author:
Saldarriaga Omar A.,Dye Bradley,Pham Judy,Wanninger Timothy G.,Millian Daniel,Kueht Michael,Freiberg Benjamin,Utay Netanya,Stevenson Heather L.
Abstract
AbstractDirect-acting antivirals (DAA) have replaced interferon (IFN)-based therapies for hepatitis C virus. In this retrospective clinical study, we examined differences in histopathologic features in paired liver biopsies collected from the same patient before and after DAA and correlated these findings with clinical outcome. Biopsies (n = 19) were evaluated by quantitative imaging analysis to measure steatosis and fibrosis. Most patients had decreased steatosis in their post-treatment, follow-up biopsies. However, one patient had a striking increase in steatosis (from 0.86 to 6.32%) and later developed decompensated cirrhosis and hepatocellular carcinoma (HCC). This patient had a marked increase in fibrosis between biopsies, with a CPA of 6.74 to 32.02. Another patient, who already had bridging fibrosis at the time of her pre-treatment biopsy, developed cholangiocarcinoma after DAA. Even though the overall inflammatory activity in the post-treatment biopsies significantly decreased after treatment, 60% of patients had persistent portal lymphocytic inflammation. In summary, DAAs decreased steatosis and hepatic inflammation in most patients, although some may have persistence of lymphocytic portal inflammation. Patients known to have advanced fibrosis at treatment initiation and who have other risk factors for ongoing liver injury, such as steatosis, should be followed closely for the development of adverse outcomes, such as portal hypertension and primary liver cancers.
Funder
National Center for Advancing Translational Services Clinical and Translational Science Awards Grant NCATS CTSA Grant KL2 Scholars Program
Moody Endowment Award, Galveston, TX
MD Anderson Cancer Center SPORE in Hepatocellular Carcinoma Grant
National Institute of Diabetes and Digestive and Kidney Diseases
Publisher
Springer Science and Business Media LLC
Reference66 articles.
1. Heidelbaugh, J. J. & Bruderly, M. Cirrhosis and chronic liver failure: part I. Diagnosis and evaluation. Am. Fam. Physician 74(5), 756–762 (2006).
2. WHO Guidelines on hepatitis B and C testing (World Health Organization, 2017).
3. El-Serag, H. B. & Kanwal, F. Epidemiology of hepatocellular carcinoma in the United States: Where are we? Where do we go?. Hepatology 60(5), 1767–1775 (2014).
4. Freeman, A. J. et al. Predicting progression to cirrhosis in chronic hepatitis C virus infection. J. Viral Hepat. 10(4), 285–293 (2003).
5. Mendes, L. S. et al. Prognostic factors for progression of liver structural lesions in chronic hepatitis C patients. World J. Gastroenterol. 14(16), 2522–2528 (2008).
Cited by
14 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献