Interferon‐free therapy as the cause of white matter tracts and cerebral perfusion recovery in patients with chronic hepatitis C

• Published in: Journal of viral hepatitis Vol. 26; no. 6; pp. 635 - 643
• Main Authors: Bladowska, Joanna, Pawłowski, Tomasz, Fleischer‐Stępniewska, Katarzyna, Knysz, Brygida, Małyszczak, Krzysztof, Żelwetro, Agnieszka, Rymer, Weronika, Inglot, Małgorzata, Waliszewska‐Prosół, Marta, Ejma, Maria, Podgórski, Przemysław, Zimny, Anna, Sąsiadek, Marek
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.06.2019
• Subjects: Anisotropy; Basal ganglia; Blood flow; Cerebral blood flow; Chronic infection; Cingulum; Cognitive ability; Cortex; Diffusion coefficient; Fibrosis; Hepatitis; Hepatitis C; Interferon; interferon‐free direct‐acting antiviral agents; Magnetic resonance imaging; Perfusion; radiology/imaging; Ribavirin; Ritonavir; Substantia alba; viral hepatitis; viral hepatitis; radiology/imaging; hepatitis C; interferon-free direct-acting antiviral agents
• ISSN: 1352-0504; 1365-2893
• DOI: 10.1111/jvh.13069

Summary The purpose of this study was to assess cerebral microstructural and perfusion changes in patients with chronic hepatitis C virus (HCV) infection before and after interferon‐free therapy, using advanced magnetic resonance (MR) techniques. Eleven HCV‐positive patients underwent diffusion tensor imaging (DTI) and perfusion‐weighted imaging (PWI) using a 1.5T MR unit, before and 24 weeks after completion of interferon‐free therapy. DTI fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were obtained from 14 white matter tracts. PWI values of relative cerebral blood volume (rCBV) and relative cerebral blood flow (rCBF) were assessed from 8 areas, including basal ganglia, and cortical and white matter locations. In HCV‐positive patients therapy with ombitasvir, paritaprevir boosted with ritonavir and dasabuvir, with or without ribavirin, was scheduled. Cognitive tests were used to assess cognitive function. We found increased FA values after interferon‐free therapy compared to values obtained before treatment in HCV patients in almost all white matter tracts. We also observed elevated rCBV values in basal ganglia after therapy. There were significant correlations between improvement in the score of cognitive tests and increased FA values in both inferior fronto‐occipital fascicles and left posterior cingulum after treatment. Liver fibrosis regression in elastography, APRI and improvement in cognitive tests were observed. This is the first report of interferon‐free therapy as the cause of white matter tracts recovery as well as cerebral perfusion improvement in HCV‐infected patients, indicating better functioning of frontal lobes after interferon‐free treatment.