Long-Term Liver Fibrosis Changes After DAA Therapy in HCV Patients With and Without HIV

Overview

This study evaluated liver fibrosis changes over 5 years post-hepatitis C cure in individuals with and without HIV using APRI, FIB-4, and ELF markers. While APRI and FIB-4 decreased early after treatment, ELF identified persistent advanced fibrosis linked to clinical events and mortality, with higher risk observed in those with HIV.

Background

Assessment of liver fibrosis after hepatitis C virus (HCV) cure is challenging due to the influence of liver inflammation on common noninvasive markers like APRI and FIB-4. The enhanced liver fibrosis (ELF) test measures direct extracellular matrix components and is more specific for fibrosis. The ACTG A5320 VHICS cohort followed participants with and without HIV who achieved sustained virologic response (SVR) after direct-acting antiviral (DAA) therapy to study long-term fibrosis evolution and clinical outcomes.

Data Highlights

Clinical events occurred in 12% of participants: 29 with HIV/HCV and 15 with HCV alone. HIV co-infection was associated with a 1.95-fold increased risk of clinical events.

Key Findings

• At study entry (~30 weeks post-DAA), ELF detected advanced fibrosis in 21% of participants, higher than APRI (1%) and FIB-4 (7%).
• ELF scores remained stable over 5 years, indicating persistent advanced fibrosis despite HCV cure.
• APRI and FIB-4 decreased early after treatment, likely reflecting reduced liver necroinflammation rather than fibrosis regression.
• Participants with HIV had nearly double the risk of clinical events compared to those without HIV.
• Lower ELF scores at study entry were associated with reduced risk of liver-related clinical events and all-cause mortality.
• ELF was a superior predictor of long-term liver outcomes compared to indirect fibrosis markers.

Clinical Implications

Clinicians should consider using ELF testing post-HCV cure to identify patients with persistent advanced fibrosis who remain at risk for liver-related complications. Early decreases in APRI and FIB-4 may not reflect true fibrosis regression. Patients with HIV co-infection require closer monitoring due to their higher risk of adverse clinical events.

Conclusion

ELF testing provides valuable long-term prognostic information on liver fibrosis after HCV cure, identifying patients at risk for clinical events and death, especially among those with HIV. Long-term follow-up beyond SVR is essential to monitor liver health.

References

1. ACTG A5320 VHICS Study Group 2024 -- Assessment of Liver Fibrosis Alterations Following DAA Treatment for Hepatitis C in Individuals With and Without HIV