Avaliação do grau de fibrose hepática em pacientes com hepatite C crônica, através de métodos não invasivos, após o tratamento com antivirais de ação direta, em um centro de referência de Belém-PA

Abstract

INTRODUCTION: Viral hepatitis represents a group of diseases of great relevance in the world and also in Brazil. Staging of chronic liver disease must be performed by any available method: Liver biopsy is a gold standard, but invasive method. Other non-invasive methods such as APRI (AST Platelet Ratio Index), FIB4 (Fibrosis-4) and hepatic elastography have been widely used. For a long time, interferon, pegylated interferon and ribavirin were used to treat hepatitis C, however, they did not achieve significant responses. In contrast, direct-acting antivirals (DAAs), now available, have shown high efficacy and tolerance. OBJECTIVE: To evaluate the degree of hepatic fibrosis in patients with chronic hepatitis C who underwent direct action antiviral therapy, demonstrating whether there was a change in the disease stage. METHOD: This study is characterized as descriptive, cross-sectional and retrospective in patients with hepatitis Chronic C seen at a Reference Unit in Belém-PA, from January 2015 to August 2019. Data collection was performed by analyzing the physical and electronic records by the authors of the research at the Patient Information Management (GIPE) of FSCMPA. Clinical data such as age, sex, stage of the disease, type and duration of treatment with direct action antivirals, platelet counts, AST, ALT and APRI, FIB4 and elastography results were evaluated. RESULTS: Data from 60 patients were collected in this study, of which 51, 67% (31) were female and 48.33% (29) male. The variation from the median before treatment to after treatment was 12 kPa to 7.4 kPa (p <0.0001) by elastography. Evaluating APRI, the median variation was from 1.51 to 0.41 (p <0.0001). For the FIB-4, the median variation was 4.02 to 1.75 (p <0.0001). CONCLUSION: The research showed that there was a statistically significant reduction in the degree of liver fibrosis in patients undergoing therapy with AEDs, according to the medical records analyzed, based on the evaluation by Fibroscan®. The same occurred when the invasive mathematical methods APRI and FIB4 were evaluated. There was also a reduction in the degree of staging by the METAVIR classification, since before treatment most patients were between stages F3 and F4, however, after treatment, most patients are between stages F1 and F2.