# Evaluation of Liver Fibrosis Change After DAA-induced Cure of Hepatitis C in Participants With and Without HIV: ACTG A5320 Viral Hepatitis C Infection Long-term Cohort Study (VHICS)

## TL;DR

This study found that liver fibrosis did not significantly improve in people cured of hepatitis C, especially those co-infected with HIV, over five years.

## Contribution

The study introduces the ELF fibrosis marker as a better predictor of ongoing liver risk after hepatitis C cure compared to traditional markers.

## Key findings

- ELF scores showed more participants had severe fibrosis compared to APRI or FIB-4.
- HCV/HIV participants had a 1.95 times higher risk of clinical events compared to HCV-only participants.
- Lower ELF scores at study entry were linked to lower risk of clinical events.

## Abstract

Change in liver fibrosis was studied over 5 years after cure of hepatitis C (HCV) in participants with and without HIV from the Viral Hepatitis C Infection Long-Term Cohort Study (VHICS). Markers of liver fibrosis included aspartate aminotransferase to platelet ratio (APRI), fibrosis 4 index (FIB-4), and a direct measure of extracellular matrix, enhanced liver fibrosis (ELF). We evaluated 122 participants without HIV and 128 with HIV. At study entry, which occurred on average 30 weeks after antiviral completion, more participants had severe fibrosis by ELF (21%) than FIB-4 (7%) or APRI (1%). ELF scores were not available before entry into VHICS. The proportions of participants in predefined ELF categories were similar between the 2 groups at study entry and over time. Advanced fibrosis by ELF did not decrease over time. Clinical events were observed in 44 (12%): 29 HCV/HIV and 15 HCV participants. HCV/HIV participants had a 1.95 times higher risk of developing a clinical event, compared to HCV. A lower entry ELF score was numerically associated with a lower risk of a clinical event. There was an association between VHICS entry ELF and time to first targeted liver diagnosis or all-cause death (hazard ratio; 95% CI, 0.268 [.094-.763], P = .014). In conclusion, APRI and FIB-4 decreases occurred early after direct-acting antiretroviral therapy, likely from decreased necroinflammation. ELF identified participants who continued to have advanced liver fibrosis and was associated with development of liver outcomes and death. Studies after sustained virologic response should include longer term follow up to monitor for clinical events.

ELF fibrosis marker, studied over 5 years after SVR, identified HCV and HCV/HIV participants with continued advanced fibrosis at higher risk of development of adverse liver outcomes and death.