Direct-acting antiviral agents for hepatitis C cirrhosis analysis of efficacy and influ-encing factors
Objective To investigate the efficacy and related influencing factors of hepatitis C cirrhosis patients trea-ted with direct-acting antiviral agents(DAAs).Methods To retrospectively analyze the improvement of virological re-sponse,serum biochemistry,and degree of hepatic fibrosis in patients with primary hepatitis C cirrhosis who attended the Department of Infection of the Sichuan Provincial People's Hospital from Sep.2017 to Apr.2022 after treatment with direct antiviral drugs such as Sofosbuvir/Velpatasvir±Ribavirin,Laedipavir/Sofosbuvir±Ribavirin,and Elvitegravir/Gravitasvir,respectively,and to explore their influencing factors.Results Of the 54 patients with hepatitis C cirrhosis included,37 patients had compensated cirrhosis and 17 patients had decompensated cirrhosis.The mean age of the pa-tients was(57.65±9.58)years old,of which 24 patients(44.44％)were male,and the mean HCV RNA load of the patients at baseline was(5.60±0.90)lgIU/ml.After treatment,90.74％of the patients achieved a rapid virologic re-sponse(RVR),with an end-of-treatment virologic response rate(ETVR)of 100％.One genotype 3b patient experi-enced viral relapse 12 weeks after the end of treatment,and 98.15％of the total population achieved sustained virologic response 12 weeks(SVR12)after the end of treatment,with 100％of the patients with decompensated cirrhosis achie-ving SVR12.Serum ALT,AST,ALB,TBIL,FIB-4 and APRI scores in the total cirrhotic population improved signifi-cantly,and there was no significant change in PLT and Scr.Further subgroup analyses showed that significant improve-ment in ALB levels occurred rapidly at 4 weeks of treatment and persisted until the end of 12 weeks of treatment in pa-tients＜60 years of age,whereas in patients ≥60 years of age,the significant improvement in ALB was delayed until the end of 12 weeks of treatment.Patients in the HCV RNA＜1×106 IU/mL group continued to show significant improvement in ALB at 4 weeks of treatment and 12 weeks at the end of treatment,while patients in the HCV RNA≥ 1×106 IU/mL group showed a significant improvement in their ALB levels only at the end of treatment at 12 weeks;FIB-4 and APRI scores significantly improved in the genotype 1b group at 4 weeks of treatment,and significant improvement in ALB was seen at the end of treatment and at the end of the 12 weeks of treatment,while there was no significant improvement in the FIB-4 scores of the genotype non-1b group,significant improvement in ALB occurred only at the end of 12 weeks of treatment;patients with compensated cirrhosis and decompensated cirrhosis showed significant improvement in blood bio-chemistry and noninvasive liver fibrosis indexes during the observation cycle from the beginning of the treatment to the end of the 12 weeks of the treatment,and the trend of the two groups was basically the same,and there was no signifi-cant difference in the SVR12 rate(P＞0.05).Conclusion After treatment with DAAs,patients with hepatitis C cir-rhosis achieved higher SVR12 rates and significant improvements in serum biochemistry and liver fibrosis.High viral load,advanced age and genetic non-type 1b are possible factors affecting the improvement of serum biochemistry and liver fibrosis indices in the short term(12 weeks after the end of treatment).
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