Objective:

To assess the long-term evolution of liver fibrosis following hepatitis C cure in participants with and without HIV, highlighting its clinical significance.

Key Findings:

• At study entry, 21% of participants had severe fibrosis by ELF, compared to 7% by FIB-4 and 1% by APRI, indicating the varying sensitivity of these markers.
• Advanced fibrosis by ELF did not decrease over time, suggesting persistent risk.
• HCV/HIV participants had a 1.95 times higher risk of developing clinical events compared to HCV-only participants, underscoring the need for targeted monitoring.
• Lower ELF scores at entry were associated with a lower risk of clinical events, indicating potential for early intervention.

Interpretation:

ELF is a valuable marker for identifying persistent advanced liver fibrosis and predicting clinical outcomes post-HCV treatment, while APRI and FIB-4 showed early decreases likely due to reduced necroinflammation, emphasizing the need for tailored follow-up strategies.

Limitations:

• ELF scores were not available before study entry, limiting baseline comparisons.
• Only data prior to HCV recurrence were analyzed for participants with recurrence, which may affect the generalizability of findings.

Conclusion:

Long-term follow-up is essential to monitor clinical events after achieving SVR in HCV patients, particularly for those with HIV, to ensure timely interventions and improve patient outcomes.