Valoración de respuesta de la enfermedad hepática mediante elastografía ARFI en pacientes con VHC tratados con antivirales de acción directa

Résumé

Hepatitis C virus infection is a public health problem which might cause chronic liver damage. Chronic liver disease can lead to extense fibrosis and cirrhosis which may increase the risk of developing hepatocellular carcinoma. The recent emergence of new antiviral therapies has revolutionized the clinical management of patients. Direct-acting antivirals have shown more efficacy than classic therapies with less side effects. Sustained virological response after treatment indicates the cure of infection, however, there is no conclusive data about the impact of treatment on natural history of liver disease, which is the main prognostic factor of the infection. Traditionally it has been considered liver biopsy to be the gold standard to assess parenchymal fibrosis secondary to HCV infection. However, this technique has been replaced in clinical practice by the combination of non-invasive methods which are able to safely predict the level of liver fibrosis, among which ARFI elastography stands out. This technique allows to noninvasively assess parenchymal stiffness, which is related to necroinflammation and fibrosis. Nowadays, the usefulness of the technique to monitor liver disease in HCV patients is questioned. The aim of our study was to analize treatment liver response by means of the combination of analytical parameters, ultrasound features and elastographic data. A prospective study was conducted with 104 HCV patients who underwent basal and post-treatment evaluation, twelve months after the end of treatment. Our results showed sustained virological response in every patient. In addition, it was verified a reduction in inflammation and fibrosis-related liver parameters and a decrease of alpha-fetoprotein. There were less patients with splenomegaly assessed with ultrasound after treatment. A reduction of liver stiffness and a decrease in METAVIR score was detected with ARFI elastography, attributed to fibrosis regression and decrease in liver inflammation. These results reveal regression of liver damage after antiviral treatment as well as the usefulness of ARFI technique for monitoring treatment response.