Liver fibrosis improvement assessed by magnetic resonance elastography and Mac‐2‐binding protein glycosylation isomer in patients with hepatitis C virus infection receiving direct‐acting antivirals

Abstract Aim Fibrosis regression has been observed in patients with chronic hepatitis C virus (HCV) infection treated with direct‐acting antivirals. This study was aimed at evaluating dynamic changes of serum Mac‐2‐binding protein glycosylation isomer (M2BPGi) in patients with HCV genotype 1 receiving elbasvir/grazoprevir. Methods M2BPGi were serially measured at baseline, during and after therapy. Its diagnostic performance at baseline and sustained virological response at 24 weeks after treatment (SVR24) were compared with transient elastography (TE) and the aspartate aminotransferase/platelet ratio index (APRI) using magnetic resonance elastography (MRE) as a reference. Results Overall, 60 HCV mono‐infected and 36 HCV/HIV co‐infected patients were included with SVR24 rates of 93.3% and 97.2%, respectively. At baseline, TE, M2BPGi and APRI were correlated with MRE ( r = 0.788, r = 0.703 and r = 0.564, respectively, p < 0.001). The area under the receiver operator characteristics curves for TE, M2BPGi and APRI in differentiating significant fibrosis were 0.88 (95% confidence interval; 0.81–0.95, p < 0.001), 0.86 (0.79–0.94, p < 0.001) and 0.74 (0.64–0.83, p < 0.001), respectively. The corresponding figures for cirrhosis were 0.95 (0.90–1.00, p < 0.001), 0.96 (0.92–1.00, p < 0.001) and 0.88 (0.79–0.97, p < 0.001), respectively. Compared with baseline, all fibrosis markers significantly declined after achieving SVR24. The correlations of TE, M2BPGi and APRI with MRE at time of SVR24 were r = 0.587 ( p < 0.001), r = 0.457 ( p < 0.001) and r = 0.293 ( p = 0.004), respectively. In multivariate analysis, high baseline alanine aminotransferase level, HCV mono‐infection and advanced fibrosis were factors associated with M2BPGi reduction. Conclusions HCV eradication is associated with liver fibrosis improvement. M2BPGi has a better performance than APRI in monitoring liver fibrosis in patients treated with direct‐acting antivirals. This marker is applicable in resource‐limited settings where imaging‐based modalities are not widely accessible.