Dynamic change of metabolic dysfunction-associated steatotic liver disease in patients with hepatitis C virus infection after achieving sustained virologic response with direct-acting antivirals

Information on the dynamics of metabolic dysfunction-associated steatotic liver disease (MASLD) among hepatitis C virus patients achieving sustained virologic response (SVR₁₂) with direct-acting antivirals (DAAs) is limited.

We enrolled 1512 eligible participants in this prospective study. MASLD was defined by a controlled attenuation parameter (CAP) of ≥248 dB/m utilizing vibration-controlled transient elastography in conjunction with presence of  ≥1 cardiometabolic risk factor. The distribution of MASLD and the changes in CAP were evaluated before treatment and at SVR₁₂. Forward stepwise logistic regression analyses were performed to determine factors significantly associated with the regression or emergence of MASLD.

The prevalence of MASLD decreased from 45.0% before treatment to 36.1% at SVR₁₂. Among 681 participants with MASLD before treatment, 144 (21%) exhibited MASLD regression at SVR₁₂. Conversely, among 831 participants without MASLD before treatment, 9 (1.1%) developed MASLD at SVR₁₂. Absence of type 2 diabetes (T2D) [odds ratio (OR): 1.73, 95% confidence interval (CI): 1.13–2.65, p = 0.011], age > 50 years (OR: 1.73, 95% CI: 1.11–2.68, p = 0.015), and alanine transaminase (ALT) ≤ 2 times the upper limit of normal (ULN) (OR: 1.56; 95% CI: 1.03–2.37, p = 0.035) were associated with the regression of MASLD. Presence of T2D was associated with the emergence of MASLD (OR: 5.83, 95% CI: 1.51–22.56, p = 0.011).

The prevalence of MASLD decreased after achieving SVR₁₂ with DAAs. Patients with pre-existing T2D showed a diminished probability of MASLD regression and a heightened risk of MASLD emergence post-SVR₁₂.