Effectiveness of Direct-Acting Antivirals in Treatment of Elderly Egyptian Chronic Hepatitis C Patients

Genotypes of Hepatitis C Virus and Efficacy of Direct-Acting Antiviral Drugs among Chronic Hepatitis C Patients in a Tertiary Care Hospital

Hepatitis C virus (HCV) chronic infection is a major causative factor for several chronic liver diseases, including liver cirrhosis, liver cell failure, and hepatocellular carcinoma. The HCV has seven major genotypes. Genotype 4 is the most prevalent genotype in the Middle East, including Saudi Arabia, followed by genotype 1. The HCV genotype affects the response to different HCV treatments and the progression of liver disease. Currently, combinations of direct-acting antiviral drugs (DAAs) approved for the treatment of HCV achieve high cure rates with minimal adverse effects. Because real-world data from Saudi Arabia about the efficacy of DAAs are still limited, this study was conducted to assess the effectiveness of DAAs in treating patients with chronic hepatitis C and to identify the variables related to a sustained virologic response (SVR) in a real-world setting in Saudi Arabia. This prospective cohort study included 200 Saudi patients with chronic HCV who were 18 years of age or older and had been treated with DAAs at King Abdul-Aziz Specialized Hospital in Taif, Saudi Arabia, between September 2018 and March 2021. The response to treatment was assessed by whether or not an SVR had been achieved at week 12 post treatment (SVR12). An SVR12 was reached in 97.5% of patients. SVR12 rates were comparable for patients of different ages, between men and women, and between patients with and without cirrhosis. In addition, the SVR12 rates did not differ according to the infecting HCV genotype. In this study, the presence of cirrhosis and the patient's gender were independent predictors of who would not reach an SVR12 (known here as the non-SVR12 group) according to the results of univariate and multivariate binary logistic regression analyses based on the determinants of SVR12. In this population of patients with chronic HCV infection, all DAA regimens achieved very high SVR12 rates. The patients' gender and the presence of cirrhosis were independent factors of a poor response.

Correlation of host factor with virological response to direct-acting antiviral treatment in hepatitis C patients

Background

Hepatitis C virus (HCV) infection is the global epidemic of this century, affecting almost 100 million people, and it is now the leading cause of liver-related mortality and liver transplantation. Interferon (IFN)-α was introduced as the first treatment for chronic hepatitis C but had several limitations, including factors that cause unresponsiveness to therapy, such as viral and host factors. The availability of non-interferon antiviral agents, direct-acting antivirals (DAAs), has led to a major paradigm shift in the treatment of HCV infection. This therapy has been shown to achieve higher cure rates and minimal side effect profiles in clinical trials. This study is aimed to determine the correlation between host factors, such as age, gender, and body mass index (BMI) with virological response to DAA treatment in hepatitis C patients.

Result

Observational research with a retrospective cohort approach was conducted at Wahidin Sudirohusodo Hospital, Makassar, Indonesia, from April 2021 to October 2021. The virological response was assessed using HCV-RNA quantitative and sustained virological response (SVR) 12 weeks after therapy. The research was conducted on 86 subjects consisting of 57 men and 29 women with a mean age of 48.69±13.94 years and mean BMI of 23.17±3.71 kg/m2, with SVR12 up to 90.7%. Study analysis did not find a significant correlation between age, gender, and BMI, with virological response SVR12 of chronic hepatitis C patients with direct-acting antiviral (p>0.05).

Conclusion

Age, gender, and body mass index do not influence the success of DAA therapy.

Correlation of host factor with virological response to direct-acting antiviral treatment in hepatitis C patients

Background

Hepatitis C virus (HCV) infection is the global epidemic of this century, affecting almost 100 million people, and it is now the leading cause of liver-related mortality and liver transplantation. Interferon (IFN)-α was introduced as the first treatment for chronic hepatitis C but had several limitations, including factors that cause unresponsiveness to therapy, such as viral and host factors. The availability of non-interferon antiviral agents, direct-acting antivirals (DAAs), has led to a major paradigm shift in the treatment of HCV infection. This therapy has been shown to achieve higher cure rates and minimal side effect profiles in clinical trials. This study is aimed to determine the correlation between host factors, such as age, gender, and body mass index (BMI) with virological response to DAA treatment in hepatitis C patients.

Result

Observational research with a retrospective cohort approach was conducted at Wahidin Sudirohusodo Hospital, Makassar, Indonesia, from April 2021 to October 2021. The virological response was assessed using HCV-RNA quantitative and sustained virological response (SVR) 12 weeks after therapy. The research was conducted on 86 subjects consisting of 57 men and 29 women with a mean age of 48.69±13.94 years and mean BMI of 23.17±3.71 kg/m2, with SVR12 up to 90.7%. Study analysis did not find a significant correlation between age, gender, and BMI, with virological response SVR12 of chronic hepatitis C patients with direct-acting antiviral (p>0.05).

Conclusion

Age, gender, and body mass index do not influence the success of DAA therapy.

Usefulness of Noncontrast MRI-Based Radiomics Combined Clinic Biomarkers in Stratification of Liver Fibrosis

PURPOSE

To develop and validate a radiomic nomogram based on texture features from out-of-phase T1W images and clinical biomarkers in prediction of liver fibrosis.

MATERIALS AND METHODS

Patients clinically diagnosed with chronic liver fibrosis who underwent liver biopsy and noncontrast MRI were enrolled. All patients were assigned to the nonsignificant fibrosis group with fibrosis stage <2 and the significant fibrosis group with stage ≥2. Texture parameters were extracted from out-of-phase T1-weighted (T1W) images and calculated using the Artificial Intelligent Kit (AK). Boruta and LASSO regressions were used for feature selection and a multivariable logistic regression was used for construction of a combinational model integrating radiomics and clinical biomarkers. The performance of the models was assessed by using the receiver operator curve (ROC) and decision curve.

RESULTS

ROC analysis of the radiomics model that included the most discriminative features showed AUCs of the training and test groups were 0.80 and 0.78. A combinational model integrating RADscore and fibrosis 4 index was established. ROC analysis of the training and test groups showed good to excellent performance with AUC of 0.93 and 0.86. Decision curves showed the combinational model added more net benefit than radiomic and clinical models alone.

CONCLUSIONS

The study presents a combinational model that incorporates RADscore and clinical biomarkers, which is promising in classification of liver fibrosis.

Assessment of Plasma Vitronectin as Diagnostic and Prognostic Marker of Hepatocellular Carcinoma in Patients with Hepatitis C Virus Cirrhosis

Background: hepatitis C is an inflammatory liver disease caused by the hepatitis C infection (HCV), and without treatment, almost 50% will progress to liver cirrhosis. Hepatocellular carcinoma (HCC) is the most frequent type of primary liver cancer and the fourth leading cause of cancer-related mortality. Aim of the study: the objective of this study was to evaluate the serum level of vitronectin (VTN) compared to AFP and determine their role as diagnostic and prognostic markers of HCV-related liver diseases. Subject and Methods: this study involved 52 HCV patients from which 26 patients were cirrhotic, and 26 patients had HCC (on top of hepatitis C virus-related cirrhosis) plus 10 healthy people as a control group. It was carried out in Gastroenterology and Hepatology Unit, Internal Medicine Department, Zagazig University Hospitals, Egypt. All individuals in this study were subjected to physical examination, full history taking, liver function tests, assessment of serum levels of Vitronectin (VTN) and alpha-fetoprotein (AFP) before and after the intervention within three months. Results: serum level of vitronectin increased significantly in cirrhosis patients and HCC patients than controls (p = 0.0041), (p < 0.001), respectively, and in HCC than cirrhosis patients (p < 0.001). Significant positive correlations were observed between levels of serum VTN and AFP in all HCV patients as well as cirrhotic patients (p < 0.001, p = 0.011, respectively). On the contrary, VTN and AFP didn’t show a significant correlation in HCC patients’ group. Moreover, the median serum level of VTN decreased significantly after treatment in patients with HCC (p < 0.001). At cut-off 38.5 ng/mL for AFP it shows sensitivity 80.8%, specificity 76.9% to differentiate HCC from cirrhosis cases. While VTN shows 84.6% sensitivity, 96.2% specificity at cut-off 26.5 μg/mL. Regarding clinicopathological characteristics and VTN levels, half of patients were stage B, 63.9% had tumor size >3 cm, 84.6% had more than one focal lesion. Conclusions: these results may allow one to speculate a potential role of Vitronectin in diagnosis and prognosis of HCC on top of cirrhosis related to HCV infection in addition to AFP and US and CT.