Evaluation of hyaluronic acid and type III procollagen peptide as predictors for treatment response to direct-acting antivirals.

Background: Treatment response to direct-acting antivirals (DAAs) is a challenging issue and the identification of non-responders patients is very important.

Aim: To evaluate the relation between baseline serum levels of hyaluronic acid (HA) and type III procollagen N-peptide (PIIINP) with direct-acting antivirals treatment failure in Egyptian patients with chronic hepatitis C.

Methods: Hepatitis C patients (responders and non-responders to sofosbuvir/daclatasvir) were tested for HA and PIIINP using sensitive chemiluminescent immunoassay.

Results: There were distinctly higher PIIINP (P = 0.0003) and HA (P < 0.0001) levels in non-responders than responders patients with a good ability for distinguishing non-responders from patients with sustained virological response (area under the curve = 0.766 for HA and 0.684 for PIIINP). Logistic regression analysis revealed that the HA × PIIINP is the model with the highest predictive ability (area under the curve = 0.809). Diagnostic performances were superior to each marker alone with good sensitivity (74.7%), specificity (74%), positive predictive (68.3%), negative predictive values (79.6%) and accuracy (74.3%). The multiplication of HA × PIIINP is correlated significantly (P < 0.05) with elevated liver enzymes (r = 0.212), decreased albumin (r = -0.26), elevated aspartate aminotransferase-platelet ratio index (r = 0.223) and elevated fibrosis-4 score (r = 0.216) scores.

Conclusion: These findings suggested the remarkable role of fibrogensis markers HA and PIIINP in the prediction of hepatitis C virus DAAs treatment response. Multiplying HA with PIIINP values increase the sensitivity to detect treatment success and thus may aim to improve treatment duration and the disease control.