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World J Hepatol. Jun 27, 2022; 14(6): 1120-1130
Published online Jun 27, 2022. doi: 10.4254/wjh.v14.i6.1120
Fibrosis regression following hepatitis C antiviral therapy
Aisha Elsharkawy, Reham Samir, Mohamed El-Kassas
Aisha Elsharkawy, Reham Samir, Department of Endemic Medicine and Hepatogastroenterology, Faculty of Medicine, Cairo University, Cairo 11566, Egypt
Mohamed El-Kassas, Department of Endemic Medicine, Faculty of Medicine, Helwan University, Cairo 11795, Egypt
Author contributions: All authors equally contributed to this paper with conception and design of the work, literature review, drafting and critical revision, editing, and final approval of the final version of the manuscript.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mohamed El-Kassas, MD, MSc, PhD, Professor, Department of Endemic Medicine, Faculty of Medicine, Helwan University, Helwan, Cairo 11795, Egypt. m_elkassas@hq.helwan.edu.eg
Received: January 29, 2022
Peer-review started: January 29, 2022
First decision: April 10, 2022
Revised: April 16, 2022
Accepted: May 12, 2022
Article in press: May 12, 2022
Published online: June 27, 2022
Processing time: 145 Days and 4.2 Hours
Abstract

Hepatitis C virus (HCV) infection is one of the most common causes of liver pathology. It is a major etiological factor of continuous liver injury by triggering an uncontrolled inflammatory response, causing liver fibrosis and cirrhosis. Liver fibrosis is a dynamic process that can be reversible upon timely cessation of the injurious agent, which in cases of HCV is represented by the sustained virological response (SVR) following antiviral therapies. Direct-acting antiviral therapy has recently revolutionized HCV therapy and minimized complications. Liver fibrosis can be assessed with variable invasive and non-invasive methods, with certain limitations. Despite the broad validation of the diagnostic and prognostic value of non-invasive modalities of assessment of liver fibrosis in patients with HCV, the proper interpretation of liver stiffness measurement in patients after SVR remains unclear. It is also still a debate whether this regression is caused by the resolution of liver injury following treatment of HCV, rather than true fibrosis regression. Regression of liver fibrosis can possess a positive impact on patient's quality of life reducing the incidence of complications. However, fibrosis regression does not abolish the risk of developing hepatocellular carcinoma, which mandates regular screening of patients with advanced fibrosis.

Keywords: Fibrosis regression; Hepatitis C virus; Direct-acting antivirals; Hepatocellular carcinoma; Liver fibrosis; Cirrhosis

Core Tip: Hepatitis C virus (HCV) infection is one of the most common causes of hepatitis that results in continuous liver injury. Uncontrolled inflammatory responses result in liver fibrosis and cirrhosis. Liver fibrosis is a dynamic process that can be reversible upon timely cessation of the injurious agent. In cases of HCV, achievement of sustained virological response by antiviral therapies might be accompanied by regression of liver fibrosis and improvement of the patient's clinical profile. Assessment of liver fibrosis can be done with invasive and non-invasive methods, with certain limitations. Fibrosis regression can positively impact patients' quality of life, reducing complications.