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Abstract Details
Impact Of Direct Acting Antiviral Agents On Liver Function In Patients With Chronic Hepatitis C Virus Infection
Philip J Johnson1, Sarah Berhane1, Alex J Walker2, Fiona H Gordon3, Steven D Ryder45, Stuart McPherson6, Aravamuthan Sreedharan7, Andrew A Ustianowski8, Kosh Agarwal9, David Mutimer10, Takeshi Kumada11, Hidenori Toyoda12, William L Irving5, HCV Research UK
Author information
1Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool.
2Centre for Evidence Based Medicine, Department of Primary Care Health Sciences, University of Oxford, Oxford.
3Bristol Royal Infirmary, Bristol.
4Nottingham University Hospitals NHS Trust, Nottingham.
5NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham.
6Newcastle upon Tyne Hospitals NHS Foundation Trust; Translational and Clinical Research Institute, Newcastle University.
8School of Medical Sciences, University of Manchester.
9Institute of Liver Studies, King's College Hospital, London.
10University Hospitals Birmingham NHS Foundation Trust Queen Elizabeth Hospital, Queen Elizabeth Medical Centre, Birmingham.
11Department of Nursing, Faculty of Nursing, Gifu Kyoritsu University, Ogaki, Gifu, Japan.
12Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Gifu, Japan.
Abstract
Whilst the benefit of Direct Acting Antiviral Agents (DAAs) in achieving sustained virological response (SVR) is now well-accepted their impact on liver function, particularly in relation to achievement of SVR, has not been well documented. We studied 2394 patients with chronic HCV infection, 1276 receiving DAAs and 1118 interferon-based therapy. Liver function was assessed by the ALBI score or grade. Overall survival according to SVR status and baseline ALBI grade was examined. We also studied time to first decompensation according to ALBI grade, as well as longitudinal changes in ALBI score over time according to SVR.Among the patients receiving DAAs, 89% achieved SVR (Japan=99%, UK=78%). Amongst the decompensated patients in the UK cohort, three distinct risk groups according to ALBI grade at baseline were observed. The UK patients receiving DAAs, who had predominantly decompensated disease, showed clear evidence of improvement of liver function detectable within two years of the start of treatment, especially in those achieving SVR. These early changes in liver function were very similar to those observed in the first 2-3 years after interferon-based therapy. DAAs improve liver function especially in those with decompensated disease who achieve SVR. Experience with interferon-based therapy suggests that failure to achieve SVR is associated with long-term decline in liver function and, in contrast, patients who do achieve SVR can expect long-term disease improvement and subsequent stabilisation of liver function. Our initial analysis suggests that those receiving DAAs are likely, in the long term, to follow a similar course.