الفهرس 
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Abstract
Background & Aim of the work : Liver fibrosis is the main prognostic factor in chronic hepatitis C (HCV) infection as it determines morbidity and mortality. Several studies have reported regression of fibrosis in chronic HCV patients, as measured by vibration-controlled transient elastography (VCTE), among adults successfully treated with direct-acting antiviral (DAA) therapy. We aimed to investigate changes in noninvasive assessments of liver fibrosis after successful viral eradication in a cohort of Egyptian adolescents. Materials and Methods : This single-center, prospective observational cohort study was conducted at Mansoura University Children`s Hospital, Egypt. Patients were recruited from April 1st, 2018 to March 30th, 2019 through the governmental mass HCV screening and treatment program. The study included adolescents with chronic HCV who received ledipasvir/ sofosbuvir therapy and achieved sustained virological response (SVR12). Liver stiffness measurements (LSM) by VCTE and non-invasive fibrosis scores (FIB-4 and APRI) were obtained before starting and 12 months after completion of treatment. The primary outcome was decrease in LSM of more than 30% relative to baseline and changing fibrosis stage for those with >F0-1 at baseline, or maintenance of F0-1 for those F0-1 at baseline. The secondary outcomes were changes in calculated fibrosis scores with treatment and the proportion of patients with baseline fibrosis stage by LSM consistent with ≥ F2 who had post-treatment stage < F2. Results: Analyzing 85 patients, the median baseline LSM was 5.8 (IQR 4.2-6.5) and at follow-up 5.1 (IQR 4-6) kPa, P=0.045. Sixty-two (73%) met the primary outcome; 16 (19%) regression and 46 (54%) non-progression of LSM. Of 18 with initial fibrosis ≥ F2; 13 regressed to F0-1 and 2 to F5, 1 unchanged F3, 1 increased to F3 and 1 to F4. Among 67 with baseline fibrosis F0-F1, 62 were unchanged and 5 increased; 4 to F2 and 1 to F3. Although 23 (27%) had > 30% LSM increment, only 7 (8%), with associated comorbidities (4 β-thalassemia, 3 hepatic steatosis), had increased fibrosis stage. The median baseline FIB-4 and APRI scores were 0.34 (IQR 0.22-0.47) and 0.35 (0.24-0.57), while at follow-up 0.3 (IQR 0.22-0.34) and 0.2 (0.18-2.8) (P <.001, <.001), respectively. Conclusion : HCV eradication by DAA therapy among Egyptian adolescents is associated with non-progression or regression of liver fibrosis in the majority of cases, as assessed by non-invasive fibrosis measurements, twelve-months after completion of treatment.