Liver cT(1) decreases following direct-acting antiviral therapy in patients with chronic hepatitis C virus

PURPOSE: Direct-acting antiviral therapies (DAAs) for treatment of chronic hepatitis C virus (HCV) have excellent rates of viral eradication, but their effect on regression of liver fibrosis is unclear. The primary aim was to use magnetic resonance imaging (MRI) and spectroscopy (MRS) to evaluate changes in liver fibrosis, liver fat and liver iron content (LIC) in patients with chronic HCV following treatment with DAAs. METHODS: In this prospective study, 15 patients with chronic HCV due to start treatment with DAAs and with transient elastography (TE) > 8 kPa were recruited consecutively. Patients underwent MRI and MRS at baseline (before treatment), and at 24 weeks and 48 weeks after the end of treatment (EoT) for the measurement of liver cT(1) (fibroinflammation), liver fat and T(2)* (LIC). RESULTS: All patients achieved a sustained virological response. Liver cT(1) showed significant decreases from baseline to 24 weeks post EoT (876 vs 806 ms, p = 0.002, n = 15), baseline to 48 weeks post EoT (876 vs 788 ms, p = 0.0002, n = 13) and 24 weeks post EoT to 48 weeks post EoT (806 vs 788 ms, p = 0.016, n = 13). Between baseline and 48 weeks EoT significant reduction in liver fat (5.17% vs 2.65%, p = 0.027) and an increase in reported LIC (0.913 vs 0.950 mg/g, p = 0.021) was observed. CONCLUSION: Liver cT(1) decreases in patients with chronic HCV undergoing successful DAA treatment. The relatively fast reduction in cT(1) suggests a reduction in inflammation rather than regression of fibrosis. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00261-020-02860-5) contains supplementary material, which is available to authorized users.