953 Sustained Decline of Noninvasive Fibrosis Index Values in Patients with Chronic Hepatitis C (CHC) with Sustained Virologic Response (SVR) after Receiving Direct-Acting Antiviral Agents (Daas)

INTRODUCTION: DAAs for CHC are highly effective at achieving SVR. However, there are limited data on outcomes post-SVR. Our aim was to investigate the temporal effect of DAAs on the outcomes of hepatic fibrosis by non-invasive assessment and incidence of HCC post-SVR. METHODS: Retrospective longitudinal study in adults with CHC who received DAAs between 2014 and 2018 and achieved SVR at 12 weeks (SVR12) and/or 24 weeks (SVR24). Data abstracted included demographic data, pre-treatment fibrosis stage, DAA regimen, clinical and laboratory data post-SVR. Fibrosis level was determined post-SVR using APRI and FIB-4. Co-primary study outcomes were FIB-4 values and APRI values post-SVR, and incidence of hepatocellular carcinoma. ANOVA and two-sample t-test statistical analyses were performed using Microsoft Excel. RESULTS: A total of 532 patients were identified retrospectively. Median age at the end of treatment was 60 (55–65) years, 306 (57.5%) were men, baseline median APRI was 0.92, baseline median FIB-4 was 2.67, and 230/532 (43%) were F4 pre-treatment (Table 1). Hispanics had a higher level of pretreatment fibrosis than non-Hispanics (P < 0.01) and higher BMI than whites and Asians (P < 0.001). We observed a significant sustained reduction in APRI scores post-treatment at SVR12/24, and 1 and 2 years post-SVR and FIB-4 scores at 2 years post-SVR within all fibrosis groups and all races (Tables 2 and 3). Hispanics in our cohort had significantly higher fibrosis levels at 1 and 2 years post SVR compared to blacks and Asians (P < 0.01 and P < 0.05, respectively) but not whites. 159 (70%) women and 224 men (73%) achieved a normal ALT less than 25 or 33. 72% of whites, 67 % of Asians, 81% of blacks, and 76% of Hispanics achieved normal ALT level. 22 (4.14%) patients developed hepatocellular carcinoma (HCC) post-treatment; all had F4 fibrosis prior to treatment initiation. CONCLUSION: In a cohort of HCV patients with high prevalence of advanced fibrosis,treatment with DAAs lead to significant improvement in fibrosis indices, across all initial fibrosis stages and races at 1 and 2 years post-SVR. In our cohort, Hispanics had higher baseline fibrosis levels and BMI yet still had a sustained significant improvement 2 years post-SVR though fibrosis levels still remained higher than Asians and blacks. The risk of HCC post-SVR remains in patients with F4 fibrosis.