Introduction
Hepatitis C virus (HCV) infection is a major global health problem, with approximately 170 million (2.3%) infected individuals worldwide.1 These patients are more prone to develop chronic liver disease, cirrhosis and eventually hepatocellular carcinoma (HCC). HCV infection is recognized as an underlying cause in about a quarter of patients diagnosed with HCC and liver cirrhosis.2-4 Based on statistical models, the prevalence of chronic HCV infection in Iran was estimated to be 186,500 in 2014 and is expected to increase to 213,700 by 2030.5 Moreover, three-to-four-fold increase in the number of decompensated cirrhosis, HCC, and liver disease deaths because of HCV was speculated by 2030.5
It has been reported that about half of patients with chronic HCV infection demonstrate high grades of steatosis.6Severity of liver stiffness (LS) and fibrosis stage are of the most important prognostic factors in these patients. Antiviral therapy has shown to be effective in hepatic inflammation reduction and subsequent fibrosis regression.6 Also, a successful viral eradication with sustained virologic response (SVR) has been associated with decreased liver-related morbidity and mortality, including cirrhosis and HCC.7,8 Consequently, a routine assessment of liver fibrosis and steatosis is recommended to be a part of management in chronic HCV-infected patients.
Interferon (IFN)-based therapy was routinely used for treatment of chronic HCV infection. Previous studies have reported that IFN-based therapies significantly reduce the alanine aminotransferase (ALT) level and severity of liver fibrosis. However, serious side effects have limited the application of this therapeutic regimen.9-12 In recent years, appearance of direct-acting antiviral agents (DAAs) has made a great impact on the treatment of these patients with high SVR rate and favorable safety profile.13 A fixed-dose combination of sofosbuvir 400 mg and daclatasvir 60 mg is the first DAA therapy that has become available in Iran. Although many studies have addressed the efficacy of this dual DAA therapy, there are still insufficient data on the effect of this regimen on liver fibrosis.14,15
Even though liver biopsy is being considered as a gold standard method for liver fibrosis evaluation, it is not routinely used during follow-up visits of chronic HCV-infected patients. Its invasiveness, possible sampling errors and diversity of the tests’ interpretation in addition to the need for frequent liver evaluation lie among the reasons for its exclusion.16 Therefore, it is essential to develop a feasible, non-invasive procedure. In this regard, transient elastography (TE) has been introduced as a valuable screening method for early detection of liver fibrosis in chronic liver diseases.17-20 Besides, hepatic steatosis which is a major risk factor of HCC development in chronic HCV infection, could be measured quantitatively by controlled attenuation parameter (CAP) of TE.21
Here we aim to evaluate the changes in severity of liver fibrosis and steatosis using transient elastography method before and six months after the end of treatment (EOT) with the combination of sofosbuvir and daclatasvir in HCV-infected cirrhotic patients.