Reply to correspondence on “Adverse impact of metabolic dysfunction on fibrosis regression following direct-acting antiviral therapy: A multicenter study for chronic hepatitis C” Chen-Hua Liu, Yu-Ping Chang Clinical and Molecular Hepatology.2025; 31(2): e232. CrossRef
Background/Aims Direct-acting antivirals (DAAs) effectively eradicate hepatitis C virus. This study investigated whether metabolic dysfunction influences the likelihood of fibrosis regression after DAA treatment in patients with chronic hepatitis C (CHC).
Methods This multicenter, retrospective study included 8,819 patients diagnosed with CHC who were treated with DAAs and achieved a sustained virological response (SVR) between January 2014 and December 2022. Fibrosis regression was defined as a 20% reduction in noninvasive surrogates for liver fibrosis, such as liver stiffness (LS) measured by vibration-controlled transient elastography (VCTE) and the fibrosis-4 (FIB-4) score. Hypercholesterolemia (h-TC) was defined as >200 mg/dL.
Results The median age of the study population was 59.6 years, with a predominance of male patients (n=4,713, 57.3%). Genotypes 1, 2, and others were confirmed in 3,872 (46.2%), 3,487 (41.6%), and 1,024 (12.2%) patients, respectively. Diabetes mellitus (DM) was present in 1,442 (17.2%) patients and the median LS was 7.50 kPa (interquartile range, 5.30–12.50). Multivariate analysis revealed that the presence of DM and pre-DAA h-TC were independently associated with a decreased probability of fibrosis regression by VCTE. Additionally, pre-DAA h-TC was independently associated with a decreased probability of fibrosis regression by the FIB-4.
Conclusions Metabolic dysfunction has an unfavorable influence on fibrosis regression in patients with CHC who achieve SVR after DAA treatment.
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Some recent studies have found regression of liver cirrhosis after antiviral therapy in patients with hepatitis C virus (HCV)-related liver cirrhosis, but there have been no reports of complete regression of esophageal varices after interferon/ peg-interferon and ribavirin combination therapy. We describe two cases of complete regression of esophageal varices and splenomegaly after interferon-alpha and ribavirin combination therapy in patients with HCV-related liver cirrhosis. Esophageal varices and splenomegaly regressed after 3 and 8 years of sustained virologic responses in cases 1 and 2, respectively. To our knowledge, this is the first study demonstrating that complications of liver cirrhosis, such as esophageal varices and splenomegaly, can regress after antiviral therapy in patients with HCV-related liver cirrhosis.
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Direct-acting antiviral therapy reduces variceal rebleeding and improves liver function in hepatitis C virus-related cirrhosis: A multicenter retrospective cohort study Raafat SA Abdel Hafez, Atteyat A Semeya, Rasha Elgamal, Amira AA Othman World Journal of Hepatology.2025;[Epub] CrossRef
Long term changes in thrombocytopenia and leucopenia after HCV eradication with direct-acting antivirals Kazuto Tajiri, Kazuhiko Okada, Hiroyuki Ito, Kengo Kawai, Yoshiro Kashii, Yoshiharu Tokimitsu, Nozomu Muraishi, Aiko Murayama, Yuka Hayashi, Masami Minemura, Terumi Takahara, Yukihiro Shimizu, Ichiro Yasuda BMC Gastroenterology.2023;[Epub] CrossRef
Small Esophageal Varices in Patients with Cirrhosis—Should We Treat Them? Thomas Reiberger, Theresa Bucsics, Rafael Paternostro, Nikolaus Pfisterer, Florian Riedl, Mattias Mandorfer Current Hepatology Reports.2018; 17(4): 301. CrossRef
Hae Jung Song, M.D., Yun Soo Kim, M.D.2, Chang Hee Han, M.D., Jae Young Jang, M.D.,
Jung Hoon Kim, M.D.1, Young Koog Cheon, M.D., Young Seok Kim, M.D., Jong Ho Moon, M.D.,
Young Deok Cho, M.D., Chan Sup Shim, M.D., Kui Hyang Kwon, M.D.1, and Boo Sung Kim, M.D.
Overexpression of cyclooxygenase-2 (COX-2) has been associated with hepatocarcinogenesis. Inhibitors of COX-2 have proapoptotic and antiproliferative effects on malignant tumors and inhibit tumor invasion to the surrounding tissues. We report here a case of complete regression of advanced hepatocellular carcinoma (HCC) during COX-2 inhibitor administration. An eighty-year-old female was diagnosed as an advanced HCC, which was associated with HCV infection. She received COX-2 inhibitor for 3 months due to degenerative arthritis of both knees. Tumor enhancement on arterial phase CT completely disappeared without specific treatment for the HCC, and the tumor size decreased on the follow-up CT scan. (Korean J Hepatol 2006; 12:449-454)
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