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Objectives: Direct‐acting antiviral agents achieve a high cure rate, resulting in early hepatic necroinflammatory resolution and sustained fibrosis regression. This study aimed to obtain longitudinal, concurrent within‐subject measurements of liver stiffness (LS) and spleen stiffness (SS) and their correlates over time. Methods: Participants with hepatitis C (n = 592) receiving direct‐acting antiviral‐based therapy were monitored through point shear‐wave elastography from the treatment baseline (TW0) across follow‐up visits in terms of LS and SS. Results: Generalized linear mixed modeling indicated that all LS values (2301 visits) were negatively correlated with the follow‐up times (all P <.05) from TW0 to 24 weeks (PW24) after the end of treatment (EOT) and positively correlated with baseline LS values (P <.001). The slopes of declines (preceding minus next) differed significantly (P <.001) between TW0–TW4 (treatment week 4) (0.060 [−0.050 to 0.225] meter/second/month [m/s/mo]) and TW4–EOT (0.010 [−0.030 to 0.075] m/s/mo). All SS values (1704 visits) were negatively correlated with time only at PW24 (P <.001) and positively correlated with baseline SS values (P <.001). The slopes of the SS values differed significantly (P <.001) only between EOT–PW12 (−0.010 [−0.110 to 0.083] m/s/mo) and PW12–PW24 (0.043 [−0.063 to 0.160] m/s/mo). Conclusions: The biphasic fast‐to‐slow decline in LS occurred early in the on‐treatment phase, which is consistent with the resolution of hepatic necroinflammation. The slow‐to‐fast decline in SS occurred off treatment. Future studies should investigate the association with regressions in liver fibrosis and portal hypertension. [ABSTRACT FROM AUTHOR]

Abstract Background Previous research has shown variation in the effects of patient factors, including hepatic necroinflammatory activity, on liver stiffness measurement (LSM). This prospective study attempts to identify explanatory factors for LSM in patients with chronic hepatitis C (CHC) using acoustic radiation force impulse (ARFI) technology. Methods A cohort of 127 Taiwanese patients with CHC underwent ARFI LSM and immediate percutaneous liver biopsy. This study compares the concurrent diagnostic performances of LSM and FibroTest using receiver operating characteristic (ROC) curves. Three multiple linear regression models were used to evaluate the significance of concurrent patient factors in explaining LSM. Results To classify METAVIR fibrosis (F) stages, the areas under ROC curves (AUCs) were ARFI LSM, 0.847 (95% confidence interval (CI), 0.779-0.914) and FibroTest, 0.823 (95% CI, 0.748-0.898), for F1 versus F2-4; ARFI LSM, 0.902 (95% CI, 0.835-0.970) and FibroTest, 0.812 (95% CI, 0.735-0.888), for F1-2 versus F3-4; ARFI LSM, 0.831 (95% CI, 0.723-0.939) and FibroTest, 0.757 (95% CI, 0.648-0.865), for F1-3 versus F4. After adjusting for other demographic and biological covariates, biochemical and histological necroinflammatory factors consistently explained LSM. Factors included serum alanine aminotransferase (ALT)/upper limit of normal (ULN) categories (model R2 = 0.661, adjusted R2 = 0.629), ActiTest A scores (R2 = 0.662, adjusted R2 = 0.636), and METAVIR activity (A) grades (R2 = 0.651, adjusted R2 = 0.620). METAVIR F stages, body mass index, and platelet count were also independently associated with LSM. Necroinflammatory degrees, including ALT/ULN, ActiTest A scores, and METAVIR A grades, explained the false positivity of liver fibrosis staging using ARFI LSM. Conclusions The degree of hepatic necroinflammatory activity independently and significantly exaggerated liver fibrosis evaluation using ARFI LSM. However, comparisons with concurrent FibroTest indicate that ARFI LSM may be a promising alternative, or adjunctive single indicator, for liver fibrosis evaluation in patients with CHC.

Background Data on noninvasive liver fibrosis staging after viral eradication are unclear. This histology-based study validated the performance of liver stiffness (LS) measurements after viral eradication. Methods Consecutive participants with chronic hepatitis C (CHC) who received concomitant LS measurements through acoustic radiation force impulse (ARFI) elastography and percutaneous liver biopsy were prospectively screened and analyzed. Results Of the 644 patients, 521 (80.9%) underwent a biopsy at treatment baseline, and the remaining 123 (19.1%) underwent a biopsy at 3 years (median; interquartile range, 0.1) after the sustained virological response (SVR) to pegylated interferon–based and direct-acting antiviral treatments. The proportions of histological fibrosis stages did not differ significantly between the pretreatment and post-SVR groups (P =.0615). However, the LS values differed significantly (P <.0001). The median LS values (presented as shear wave velocities in meters per second) were 1.51 (0.92) for the pretreatment group and 1.22 (0.77) for the post-SVR group. The cutoffs (areas under the receiver operating characteristic curve, obtained using the bootstrap method) to dichotomize between METAVIR fibrosis stage F1 versus stages F2–F4, F1–F2 versus F3–F4, and F1–F3 versus F4 were 1.47 (0.8333, 95% confidence interval [CI] 0.7981–0.8663), 1.81 (0.8763, 95% CI 0.8376–0.9107), and 1.86 (0.8811, 95% CI 0.8378–0.9179) in the pretreatment group, respectively, and 1.22 (0.7872, 95% CI 0.7001–0.8624), 1.59 (0.8808, 95% CI 0.8034–0.9422), and 1.75 (0.9018, 95% CI 0.8201–0.9644) in the post-SVR group, respectively. Conclusions The performance of LS measurements through ARFI elastography is promising to determine the liver fibrosis stage on necroinflammation-resolved histology in CHC after viral eradication. [ABSTRACT FROM AUTHOR]

Little is known about how the initial infection and diagnosis of hepatitis C virus (HCV) impacts a patient's experience of living with and adjusting to the disease. In the present qualitative, descriptive study, we explored the initial experiences of patients in Taiwan diagnosed with HCV. Eighteen participants were recruited from hepatology clinics of a teaching hospital in Taichung, Taiwan by purposive sampling. Data were collected via in‐depth face‐to‐face interviews and analyzed by conventional content analysis. The core theme describing the illness trajectory was "Oasis in the desert". Two main themes described the participants' experiences and adjustment to the diagnosis of hepatitis C: "Getting lost in the journey" and "The calm after the storm". Our findings highlight the need for health‐care providers to coordinate interactions between patients and multi‐disciplinary teams to manage the integration of different treatment options. There is a demand for educational interventions and online information for patients and the general population, which could improve knowledge of HCV. [ABSTRACT FROM AUTHOR]