Changes in Three-Dimensional Volumetric Liver Fat Fraction after Cure of Chronic Hepatitis C Infection with Direct-Acting Antivirals

Abstract Background It remains unclear if cure of hepatitis C virus (HCV) infection with direct-acting antivirals (DAAs) leads to change in liver fat fraction and if this change differs from people without HCV observed over similar time. We evaluated the change in three-dimensional volumetric liver fat fraction by magnetic resonance imaging (MRI) prior to DAA treatment and 18 months following initiation and compared changes in uninfected controls over 18 months. Methods We conducted a cohort study of 35 participants who initiated DAAs and achieved cure and 42 without HCV infection as controls. At enrollment and 18 months later, participants had measurements of height, body weight, and three-dimensional volumetric liver fat fraction and cross-sectional area of abdominal subcutaneous and visceral adipose tissue by MRI. Multivariable linear regression was used to estimate group differences in mean changes in liver fat fraction. Results Mean change in three-dimensional volumetric liver fat fraction between Months 0 and 18 was +2.89% (95% CI: + 0.89%, + 4.88%) among participants with cured HCV and +0.48% (95% CI: -1.02%, + 1.97%) among controls (between group difference p-value=0.05). After adjustment for age, sex, smoking, and change in body mass index, the mean difference in liver fat fraction change between Months 0 and 18 was +3.11% (95% CI: + 0.46%, + 5.76%; p = 0.022) higher for participants with HCV versus controls. Conclusions Three-dimensional volumetric liver fat fraction by MRI significantly increased between Months 0 and 18 following successful treatment of HCV infection, but this finding was not observed from Month 0 to 18 among participants without HCV infection.