Previous studies have found that liver fibrosis is an important risk factor for the development of hepatocellular carcinoma (HCC) following the achievement of a sustained virologic response (SVR) in patients chronically infected with hepatitis C virus (HCV). The authors were interested in the degree of liver fibrosis changes that occur following the eradication of HCV after SVR to see if the prediction based on liver fibrosis at baseline remains valid. They followed 522 patients who achieved SVR on interferon-based therapy and updated their FIB-4 index annually. The incidence of HCC was also re-assessed annually based on the updated FIB-4 index. They found that the percentage of patients with mild liver fibrosis (FIB-4 index <1.45) increased annually after SVR, while the percentage with advanced liver fibrosis (FIB-4 index ≥3.25) decreased. This meant that the incidences of HCC based on the FIB-4 index remained constant between the time of SVR and subsequent annual updates. No patients developed HCC after SVR if their FIB-4 index decreased to <1.45. Therefore the FIB-4 index retains its predictive ability for the risk of HCC when re-calculated after SVR, despite the decrease in patients with high FIB-4 index values.
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