Clin Mol Hepatol > Accepted Articles
Adverse impact of metabolic dysfunction on fibrosis regression following direct-acting antiviral therapy: A multicenter study for chronic hepatitis C
Tom Ryu1, Young Chang1, Soung Won Jeong1, Jeong-Ju Yoo2, Sae Hwan Lee3, Sang Gyune Kim2, Young Seok Kim2, Hong Soo Kim3, Seung Up Kim4, Jae Young Jang1
1Department of Internal Medicine, Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
2Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
3Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
4Department of Internal Medicine and Yonsei Liver Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
Correspondence :  Seung Up Kim ,
Tel: +82-2-2228-1944, Fax: +82-82-2-362-6884, Email: KSUKOREA@yuhs.ac
Jae Young Jang ,
Tel: +82-2-709-9581, Fax: +82-2-709-9696, Email: jyjang@schmc.ac.kr
Received: October 12, 2024  Revised: December 20, 2024   Accepted: January 5, 2025
*Tom Ryu and Young Chang contributed equally to this work.
ABSTRACT
Background/Aims
Direct-acting antivirals (DAAs) effectively eradicate hepatitis C virus (HCV). 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) were 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.
KeyWords: direct-acting antivirals, liver fibrosis, regression, dyslipidemia, diabetes mellitus
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