eISSN: 2449-8238
ISSN: 2392-1099
Clinical and Experimental Hepatology
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3/2021
vol. 7
 
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abstract:
Original paper

Hyaluronic acid as a potential marker for assessment of fibrosis regression after direct acting antiviral drugs in chronic hepatitis C patients

Eman Rewisha
1
,
Tary Salman
1
,
Omkolsoum Alhaddad
1
,
Gamal Abo Raia
2
,
Mary Naguib
2
,
Shymaa Rashad
1
,
Ahmed Abdelfattah
1
,
Khaled Metwally
1
,
Eman Abdelsameea
1

  1. Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Egypt
  2. Clinical Pathology Department, National Liver Institute, Menoufia University, Egypt
Clin Exp HEPATOL 2021; 7, 3: 320-327
DOI: https://doi.org/10.5114/ceh.2021.109293
Online publish date: 2021/09/22
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Introduction
Fibrosis is an inevitable complication of chronic hepatitis C virus (HCV) infection. Direct acting antivirals (DAAs) radically treated HCV and were suggested to ameliorate fibrosis. Silymarin (a natural herbal remedy) was proposed to further decrease hepatic inflammation and fibrosis. Consequently, serial monitoring of liver fibrosis status by different biomarkers is needed. Aim of the study: To assess hyaluronic acid (HA) as a potential marker of fibrosis regression after DAAs in chronic HCV patients; in addition, to evaluate silymarin as an agent that, beside DAAs, could further improve fibrosis.

Material and methods
Two groups were included (150 patients each). Group 1 received DAAs only, while group 2 received DAAs followed by silymarin. Hyaluronic acid and FIB4 score were assessed at baseline before treatment and 1 year after inclusion in the study.

Results
We found that DAA therapy alone or in combination with silymarin resulted in a significant reduction in serum HA level. However, the latter case showed a statistically significantly greater reduction (p = 0.034). Mean ±SD of serum HA level was 211.8 ±179.9 and 143.3 ±123.9 µg/l before and one year after inclusion respectively in group 1 (p = 0.001) and also, its level decreased significantly in group 2 from 188.3 ±211.8 µg/l before receiving DAAs to 126.4 ±136.9 µg/l at one year after inclusion (p = 0.001). There was no significant difference between the 2 studied groups as regards FIB-4 at 1 year after inclusion (p = 0.103).

Conclusions
Hyaluronic acid might be a sensitive marker for monitoring fibrosis regression in treated chronic HCV patients. Adding silymarin to treatment protocols could ameliorate the fibrosis status.

keywords:

chronic HCV, hyaluronic acid, FIB-4, fibrosis, regression
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