O5-17. High BMI, pre-treatment cirrhosis and older age increase the risk for persisting advanced fibrosis after SVR in patients with chronic HCV

Magnus Hedenstierna [1,2], Ali Nangarhari [2], Amin El-Sabini [2], Ola Weiland [2,3], Soo Aleman [2,3,4]
Affiliates: [1] Department of Infectious Diseases, Danderyd Hospital, Stockholm Sweden. [2] Division of Infectious Diseases, Department of Medicine, Karolinska Institutet, Stockholm, Sweden. [3] Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden. [4] Department of Gastroenterology and Hepatology, Karolinska University Hospital, Stockholm, Sweden.

Background
Previous studies have shown that fibrosis can improve after treatment induced sustained virological response (SVR) in patients with chronic hepatitis C. However, a subset of patients seems to have persisting fibrosis or even progression of the baseline fibrosis. We studied the fibrosis development after SVR with transient elastography in patients with pre-treatment advanced liver fibrosis or cirrhosis (Metavir F3 or F4), and evaluated risk factors associated with persisting fibrosis.

Methods
In a cross-sectional study all patients with pre-treatment advanced liver fibrosis or cirrhosis with SVR after treatment at Karolinska University Hospital between 1992 and 2013 (n=403) were included. A clinical follow-up visit with liver stiffness measurement by FibroScan was offered. The baseline fibrosis stage, age at SVR, BMI, alcohol consumption, and the presence of diabetes at follow up was recorded at the follow up visit. The impact of these risk factors on liver stiffness at follow-up was evaluated by quantile and logistic regression.

Results
We included 269 patients with a median follow-up time from SVR of 7.7 years (range 0-20 years). Follow-up time was 10 years for 84 patients. Patients with pre-treatment cirrhosis had significantly higher median liver stiffness (8.5 kPa 95 % CI 7-9.1) at follow-up than patients with advanced fibrosis (6 kPa 95 % CI 5.5-6.4). A majority of patients improved their fibrosis stage at follow up, but 17 % of patients with cirrhosis and 13 % of patients with fibrosis stage F3 did not improve and in fact 5 % progressed. Overall 24 % of the patients had a liver elasticity level of at least 9.5 kPa at follow-up, suggesting persisting advanced liver fibrosis. This proportion diminished over time from 31 % to 15 % during prolonged follow-up time. The main risk factors for persisting advanced fibrosis were pre-treatment cirrhosis, age ≥ 55 years and BMI ≥ 25 kg/m2 with ORs of 3.9 (95 % CI 2.0-7.2), 2.3 (95 % CI 1.2-4.3) and 2.3 (95 % CI 1.1-4.6), respectively.

Conclusions
Fibrosis improves substantially after SVR has been achieved in a majority of patients with chronic hepatitis C and pre-treatment advanced liver fibrosis or cirrhosis. This improvement seems to continue over time. The main risk factors for persisting advanced fibrosis were pre-treatment cirrhosis, older age and high BMI, and special attention should be given to these risk factors at follow-up.