# Assessment of Liver Fibrosis Stage and Cirrhosis Regression After Long-Term Follow-Up Following Sustained Virological Response

## TL;DR

This study shows that most patients with advanced liver disease do not experience significant improvement in liver fibrosis after curing hepatitis C, though some with mild cirrhosis may see limited regression.

## Contribution

The study provides new insights into fibrosis regression and cirrhosis stability after long-term follow-up post-HCV cure using paired biopsies and liver stiffness measurements.

## Key findings

- Advanced fibrosis persists in most patients after HCV eradication.
- Regression is possible in mild cirrhosis (F4A) but rare in more severe cases (F4B–F4C).
- VCTE-LSM ≤ 8.6 kPa at 1 year post-EOT accurately identifies patients without advanced fibrosis.

## Abstract

Background/Objectives: Previous studies have demonstrated that the cessation of liver damage after HCV cure can improve liver function, histological necroinflammation, and portal hypertension. However, scarce data about fibrosis stage or cirrhosis regression have been reported during follow-up. Methods: A prospective study evaluating hepatic biopsies and liver stiffness measurement by vibration-controlled transient elastography (VCTE-LSM) after the end of treatment (EOT) in patients with compensated advanced chronic liver disease (cACLD). Fibrosis was evaluated according to two semi-quantitative grading systems (METAVIR and Laennec) at 6 years after EOT (LB6) and compared with biopsies at 3 years (LB3). Results: Fifty-four patients with LB6 (34 with paired LB3–LB6) were included. Median (IQR) age was 53.9 (48.5–59.3), 38 (70.4%) were men, and 13 (24.1%) were HIV-coinfected. The VCTE-LSM was >15 kPa in 30 (55.6%). The LB6 (81.4 months after EOT) showed non-advanced fibrosis (F1–F2) in 12 (22.4%) patients, bridging (F3) in 26 (48.2%), and cirrhosis (F4) in 16 (29.6%): F4A in 7 (13.0%), F4B in 4 (7.4%), and F4C in 5 (9.3%). The 1-year post-EOT follow-up VCTE-LSM ≤ 8.6 kPa identifies patients without advanced fibrosis (AUROC = 0.929), with a negative predictive value of 88.9% and a positive predictive value of 95.2%. Paired biopsies showed regression in 9 (47.4%) out of 19 patients with cirrhosis: 8 (61.5%) of 13 with F4A but only 1 (16.7%) of 6 with F4B–F4C. Conclusions: Advanced fibrosis persists in most patients with advanced chronic liver disease after HCV eradication. Regression is possible in mild cirrhosis. However, it is a limited and slow event.