#Elastography is unable to exclude #cirrhosis after sustained virological response in #HCV-infected patients with advanced chronic liver disease

Liver fibrosis and transient elastography (TE) correlation in hepatitis C virus (HCV)-infected patients with compensated advanced chronic liver disease (cACLD) after sustained virological response (SVR) is unknown.

Aims
To evaluate TE accuracy at identifying cirrhosis 3 years after HCV-eradication.

Methods
Prospective, multi-centric study including HCV-cACLD patients before direct-acting antivirals (DAA). Diagnostic accuracy of TE (area under ROC, AUROC) to identify cirrhosis 3 years after SVR was evaluated.

Results
Among 746 HCV-infected patients (95.4% with TE β‰₯10 kPa), 76 (10,2%) underwent a liver biopsy 3 years after SVR. Before treatment, 46 (63%) showed a TE>15 kPa. The TE before DAA was the best variable for predicting cirrhosis (METAVIR, F4) after SVR (AUROC=0.79). Liver function parameters, serological non-invasive tests (APRI and FIB-4), and TE values improved after SVR. However, liver biopsy 3 years after HCV-elimination (median time= 38.4 months) showed cirrhosis in 41 (53.9%). Multivariate analysis (OR (95%CI), p) showed that HCV-genotype 3 (20.81 (2.12-201.47), 0.009), and TE before treatment (1.21 (1.09-1.34), <0.001) were the only variables associated with cirrhosis after SVR. However, the accuracy of TE after SVR was poor (AUROC= 0.75) and 6 (27.3%) out of 22 patients with a TE < 8 kPa had cirrhosis. Similar results were found with APRI and FIB-4 scores.

Conclusions
cirrhosis is present, 3 years after SVR, in more than half of HCV-cACLD patients even the normalization of liver function parameters, serological non-invasive tests, and TE values. The low diagnostic accuracy of non-invasive methods after SVR reinforces the need of long-term surveillance.

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