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Morphometry confirms fibrosis regression from sustained virologic response to direct-acting antivirals for hepatitis C
Open accessAbstract
Sustained virologic response (SVR) after direct‐acting antiviral (DAA) therapy for chronic hepatitis C results in significant decreases in liver stiffness measured by transient elastography (TE). The aim of this study was to clarify if TE can guide post‐SVR management in patients with advanced fibrosis or cirrhosis prior to treatment as current guidelines are unclear on the role of TE after SVR. In total, 84 patients with hepatitis C virus and advanced fibrosis or cirrhosis and from a single center underwent DAA treatment and achieved SVR. Overall, 62% had improved liver stiffness that was consistent with regression of at least one stage of fibrosis. In the cirrhosis group, 48% showed fibrosis regression by at least two stages by TE (<9.5 kPa). In the F3 fibrosis group, 39% regressed by at least two stages (<7 kPa). The median time from SVR to regression by TE was 1 year. Fifteen patients with liver biopsies prior to SVR underwent a biopsy after SVR; 13 of these patients had improved liver stiffness (to <9.5 kPa). The post‐SVR liver biopsies of only 4 patients showed F1‐F2 while 11 patients showed F3‐F4; however, morphometry of the first 11 biopsied patients revealed that 10 patients had an average 46% decrease in collagen content. Conclusion: This is the first DAA study that also has paired liver biopsies showing fibrosis regression. After SVR is achieved, improvements in liver stiffness measured by TE are seen in a majority of patients with advanced fibrosis/cirrhosis within 2 years. TE improvements are overstated when compared to histologic staging but confirmed with morphometric analysis. It is unclear whether TE following SVR can reliably predict when patients no longer require advanced fibrosis/cirrhosis monitoring after SVR.
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Liver fibrosis can be a reversible process under certain conditions, particularly if the underlying cause of injury is removed.
“One of the most promising developments in the field is the growing consensus that liver fibrosis can be a reversible process under certain conditions, particularly if the underlying cause of injury is removed (84–86).”
From Targeting macrophages in liver fibrosis (2026) · cites this paper as [84]
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Lawitz, E. J., Shevell, D. E., Tirucherai, G. S., Du, S., Chen, W., Kavita, U., Coste, A., Poordad, F., Karsdal, M., Nielsen, M., et al. (2022) · Hepatology · doi:10.1002/hep.32181 · Cited by 107
Self-citationTargeting macrophages in liver fibrosis
González del Barrio, L., Ipsen, D. H., Pfister, D. R., Hancz, D., & Scott, C. L. (2026) · Frontiers in Immunology · doi:10.3389/fimmu.2026.1835489 · Cited by 3
Metadata
- Authors
- Pan, J. J., Bao, F., Du, E., Skillin, C., Frenette, C. T., Waalen, J., Alaparthi, L., Goodman, Z. D., & Pockros, P. J.
- Affiliations
- Scripps Clinic (US)
- Department of Pathology,La Jolla,CA
- Scripps Green Hospital (US)
- Scripps Research Institute (US)
- Inova Health System (US)
- Corresponding author
- Pockros, Paul J.
- Venue
- Hepatology Communications
- Published
- 2018-09-21
- Volume
- 2
- Issue
- 11
- Pages
- 1320-1330
- ISSN
- 2471-254X (ISSN-L)
- PMC
- PMC6211322
- OpenAlex
- W2893430689
- Cited by
- 70
- References
- 0
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 3 · 2023: 4 · 2022: 6 · 2021: 21 · 2020: 16 · 2019: 13
- FWCI
- 7.83
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Hepatology Communications (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Hepatology › Hepatitis C virus research
- Health Sciences › Medicine › Hepatology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Hepatology › Liver physiology and pathology
- Keywords
- hepatitis C, direct-acting antivirals, sustained virological response, fibrosis regression, liver stiffness, transient elastography, liver cirrhosis, advanced liver fibrosis, collagen content
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