Sa1533 REGRESSION OF HEPATIC FIBROSIS IN PATIENTS WITH CHRONIC HEPATITIS C TREATED WITH DIRECT-ACTING ANTIVIRALS (DAAS). A LONG-TERM OBSERVATIONAL STUDY.

BACKGROUND: Modified ALT criteria, ie ALT lower than 30 (in males, M)/19 (in females, F) IU/L, has been used for HBV infection, but no studies have assessed its value for HCV infection.DAAs have been the standard for HCV treatment (Rx).This and its excellent SVR rates provide us with a unique way to assess the clinical relevance of post-DAA Rx ALT and AST lower than 30 (M)/19 (F) IU/L in HCV-infected patients.METHODS: A single center, retrospective study on 129 patients received HCV Rx with 12 different DAA regimens and had post-Rx follow-up for minimal 48 weeks (wks) to assess the frequencies of pre-and post-Rx wk 48 ALT and AST < 40 or < 30 (M)/19 (F) IU/L and the associated factors by chart view and statistical analyses.RESULTS: The mean age was 60 (20-86); 53.5%, males; 38%, age > 65; 27.9%, BMI > 30 kg/m 2 ; 46.7%, stage 3-4 fibrosis; 31%, platelets < 120 x 10 9 /L; 33.3%, Child score > 6; 25.8%, MELD score > 10; 38.8%, Rx experienced; 86.8%, sofosbuvir-based regimen.Mean ALT/AST was 67.8 (4-496)/60.5 (10-244) and 17.93 (3-61)/21.44(5-89) IU/L at baseline and post-Rx wk 48, respectively.At baseline, 38.8% patients had ALT < 40; 10.9%, ALT < 30 (M)/19 (F); 42.2%, AST < 40; 8.5%, AST < 30 (M)/19 (F); 31%, both ALT/AST < 40, and 5.4%, both ALT/AST < 30 (M)/19 (F).At post-Rx wk 48, 95.3% patients had ALT < 40; 77.3%, ALT < 30 (M)/19 (F); 98.4%, AST < 40; 60.2%, AST < 30 (M)/19 (F); 95.3%, both ALT/AST < 40, 58.6%, both ALT& AST < 30 (M)/19 (F).Univariate analysis showed that male gender (p<0.001),Child score < 6 (p= 0.028), platelets ‡ 120 x 10 9/L (p=0.035),ALT/AST < 30 (M)/19 (F) at Rx wk 2 (p <0.001) and ALT/AST < 30 (M)/19 (F) at Rx wk 4 (p<0.001),but not stage 3-4 fibrosis (p=0.984) and MELD > 10 (p=0.985), were associated with both ALT/AST < 30 (M)/19 (F) post-Rx wk 48.Multivariate analysis showed that both ALT/AST < 30 (M)/19 (F) post-Rx wk 48 was associated with male gender (95% CI 1.87-36.32,p=0.003),ALT/AST < 30 (M)/19 (F) at Rx wk 4 (95% CI 1.28-24.47,p=0.016),Child score < 6 (95% CI 0.96-30.43,p=0.047), independently to platelets ‡ 120 x 10 9 /L (95% CI 0.22-5.75,p=0.885).CONCLUSION: At pre-Rx, only 10.9%, 8.5%, and 5.4% had ALT, AST, or ALT/AST < 30 (M), 19 (F) IU/ L, and that increased to 77.3%, 60.2%, and 58.6% at post-Rx wk 48, respectively.Post-Rx wk 48 ALT/AST < 30 (M)/19 (F) IU/L was independently and significantly associated with male gender, both ALT/AST < 30 (M)/19 (F) IU/L at Rx wk 4, and Child score < 6. Sa1533