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.