Effect of Treatment with Direct Acting Antivirals on Body Mass Index and Hepatic Steatosis in Chronic Hepatitis C

2018 Journal of Medical Virology In Press;

BACKGROUND: Direct Acting Agents (DAAs) have high cure rate but still lack the knowledge of their effect on hepatic steatosis in chronic hepatitis C (CHC). Controlled Attenuation Parameter (CAP), evaluated with transient elastography, could help in assessment of steatosis grades. We aim to evaluate the effect of DAAs on BMI and steatosis in CHC using CAP. PATIENTS AND METHODS: This cohort study included 155 CHC Egyptian patients divided into three groups according to the DAAs regimens. All patients were subjected to pre-treatment and 3-months post-treatment evaluation including BMI, laboratory workup and liver stiffness measurement with simultaneous CAP determination using the FibroScan((R)) M probe. RESULTS: Patients mean age was 45.78 +/- 11.6 years, 60.6% were females, mean BMI 26.63 +/- 2.75 and 18.1% were cirrhotic. Baseline assessment revealed no steatosis in 43.9%, 32.9% had mild-moderate steatosis and 23.2% had severe steatosis. The overall sustained virological response 12 was 93.6%. Follow-up revealed stationary steatosis in 56.7% of patients and regression in 21.3%. Mean pre-treatment CAP were significantly lower in responders 244.9 +/- 62.4dB/m vs non-responders; 300 +/- 28.4dB/m (p = 0.04). ROC curve delineated 273dB/m as best cutoff for detection of responders with an AUC of 0.801, sensitivity 68.2%, and specificity 100%. BMI significantly increased after treatment (p= 0.004) particularly in patients with worsened steatosis (p = 0.001). Steatosis significantly correlated with BMI (r = 0.3, p value =