Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 7, 2021; 27(5): 404-415
Published online Feb 7, 2021. doi: 10.3748/wjg.v27.i5.404
Histopathology and the predominantly progressive, indeterminate and predominately regressive score in hepatitis C virus patients after direct-acting antivirals therapy
Rui Huang, Hui-Ying Rao, Ming Yang, Ying-Hui Gao, Jian Wang, Qian Jin, Dan-Li Ma, Lai Wei
Rui Huang, Hui-Ying Rao, Ying-Hui Gao, Jian Wang, Qian Jin, Dan-Li Ma, Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing International Cooperation Base for Science and Technology on NAFLD Diagnosis, Peking University People’s Hospital, Beijing 100044, China
Ming Yang, Lai Wei, Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing 102218, China
Author contributions: Huang R, Rao HY and Wei L designed the protocol of this study; Huang R, Rao HY, Yang M, Gao YH, Wang J, Jian Q and Ma DL collected the data; Huang R and Rao HY analyzed and interpreted the patient data and were major contributors in writing the manuscript; all authors read and approved the final manuscript.
Supported by The National Natural Science Foundation of China, No. 81870406; the Beijing Natural Science Foundation, No. 7182174; and the China National Science and Technology Major Project for Infectious Diseases Control during the 13th Five-Year Plan Period, No. 2017ZX10202202.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Peking University People’s Hospital (2019PHB036-01) and informed consent was waived.
Informed consent statement: Patients were not required to give informed consent for this study as the analysis used anonymous clinical data. The Institutional Review Board of Peking University People’s Hospital approved waiving informed consent.
Conflict-of-interest statement: Dr. Rao reports grants from National Natural Science Foundation of China (NSFC) (81870406), grants from Beijing Natural Science Foundation (7182174), grants from China National Science and Technology Major Project for Infectious Diseases Control during the 13th Five-Year Plan Period (2017ZX10202202), during the conduct of the study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Hui-Ying Rao, MD, Chief Doctor, Professor, Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing International Cooperation Base for Science and Technology on NAFLD Diagnosis, Peking University People’s Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China. raohuiying@pkuph.edu.cn
Received: October 28, 2020
Peer-review started: October 28, 2020
First decision: December 3, 2020
Revised: December 14, 2020
Accepted: December 26, 2020
Article in press: December 26, 2020
Published online: February 7, 2021
Processing time: 93 Days and 5.2 Hours
ARTICLE HIGHLIGHTS
Research background

Histological changes after direct-acting antivirals (DAAs) therapy in hepatitis C virus (HCV) patients have not been elucidated. Whether the predominantly progressive, indeterminate and predominately regressive (P-I-R) score has predictive value in HCV patients has not been investigated.

Research motivation

The key issues are whether DAAs improve histopathology in HCV patients rapidly and whether the P-I-R score has predictive value in HCV patients. The results will provide important information on the histological response to DAAs therapy and the potential value of the P-I-R score in HCV patients.

Research objectives

To obtain a full understanding of the effect of DAAs on the liver, we assessed the histological changes after DAAs therapy. We also evaluated the predictive value of the P-I-R score in HCV patients.

Research methods

Chronic HCV patients with paired liver biopsy specimens before and after DAAs treatment were included. Sustained virologic response was defined as an undetectable serum HCV RNA level at 24 wk after treatment cessation. The Ishak system and P-I-R score were assessed.

Research results

Thirty-eight chronic HCV patients were included. Their mean age was 40.9 ± 14.6 years and 53% (20/38) were male. Eighty-two percent (31/38) and 37% (14/38) of patients achieved inflammation and fibrosis improvement, respectively. The P-I-R score was evaluated in 61% (23/38) of patients. In patients with stable Ishak stage after treatment: Progressive injury was seen in 22% (4/18) of patients, 33% (6/18) were classified as indeterminate and regressive changes were seen in 44% (8/18) of patients who were judged as probably reversing by the Ishak and P-I-R systems. Our results increased the knowledge on liver biopsy findings after successful HCV eradication by DAAs therapy. However, in view of the small sample size and short-term follow-up, larger and longer-term prospective studies and predictive factors for histological improvement after DAAs treatment should be performed in future studies.

Research conclusions

Significant improvement of necroinflammation and partial remission of fibrosis in HCV patients occurred shortly after DAAs therapy. The P-I-R score has potential in predicting fibrosis in HCV patients.

Research perspectives

Larger and longer-term prospective studies and predictive factors for histological improvement after DAAs treatment should be performed in future studies.