PERAN DIRECT ACTING ANTIVIRAL TERHADAP PERBAIKAN LIVER STIFFNESS PADA PASIEN HEPATITIS C KRONIK DI RSUP DR SARDJITO YOGYAKARTA

INDRIA MELIANTI, Dr. dr. Neneng Ratnasari, SpPD, KGEH ; dr. Fahmi Indrarti, SpPD, KGEH

2022 | Tesis-Subspesialis | SUBSPESIALIS ILMU PENYAKIT DALAM

Latar belakang. Virus hepatitis C merupakan salah satu penyebab penyakit hati kronik. Daerah Istimewa Yogyakarta mempunyai positif rate sebesar 0,5 persen. Patofisiologi terjadinya fibrosis, meliputi peradangan dan produksi berbagai sitokin. Tujuan terapi adalah memperlambat atau meregresi fibrosis hati. Perkembangan terbaru dengan DAA secara efisien mengendalikan viremia, namun tidak semua strategi pengobatan efektif mencegah patogenesis fibrosis hati lanjut atau sirosis. Tujuan penelitian. Penelitian ini bertujuan untuk mengetahui peran Direct Acting Antiviral terhadap perbaikan liver stiffness pada pasien hepatitis C kronik. Metode. Penelitian ini adalah penelitian observasional retrospektif dengan pre-post design. Subjek penelitian adalah pasien hepatitis C kronik yang 12 minggu telah menyelesaikan terapi DAA di poliklinik Penyakit Dalam RSUP Dr. Sardjito Yogyakarta. Dilakukan penilaian status liver stiffness sebelum terapi dan saat SVR12, berdasarkan skor APRI dan nilai transient elastography. Hasil. Didapatkan 49 subjek penelitian. Usia rerata 56,33 kurang lebih 12,08 tahun. Analisis Wilcoxon test, didapatkan penurunan bermakna median skor APRI (1,13 menjadi 0,38; p kurang dari 0,001) dan nilai transient elastography (19,45 menjadi 14,85; p = 0,021) dari sebelum terapi dan SVR12 setelah selesai terapi sofosbuvir+daclatasvir. Penurunan bermakna sebelum terapi dan SVR12 setelah selesai terapi sofosbuvir+daclatasvir, pada skor APRI kurang dari 1 (0,41 vs 0,25; p = 0,004) dan skor APRI lebih dari sama dengan 1, (1,97 vs 0,84; p kurang dari 0,001). Peningkatan transient elastography kurang dari 9,6 kPa (4,9 vs 5,0; p sama dengan 0,893) tidak bermakna secara statistik, dan penurunan bermakna transient elastography lebih dari sama dengan 9,6 kPa (21,90 vs 17; p sama dengan 0,023). Analisis Mann Whitney test, didapatkan median penurunan skor APRI dan transient elastography tidak bermakna berdasarkan variabel usia (p = 0,230 vs p = 0,420), jenis kelamin (p = 0,580 vs p = 0,582), HCV RNA kuantitatif (p = 0,967 vs p = 0,660). Kesimpulan. Direct Acting Antiviral memperbaiki liver stiffness pada pasien hepatitis C kronik. Kata kunci: Direct Acting Antiviral, hepatitis C kronik, skor APRI, transient elastography

Background. Hepatitis C virus is one of the causes of chronic liver disease. The Special Region of Yogyakarta has a positive rate of 0.5 percent. Pathophysiology of fibrosis, including inflammation and production of various cytokines. The goal of treatment is to slow down or regress liver fibrosis. Recent therapy with DAA efficiently control viremia, but not all treatment strategies can effectively prevent the pathogenesis of advanced liver fibrosis or cirrhosis. Aim. To determine the role of Direct Acting Antiviral in improving liver stiffness in chronic hepatitis C patients. Method. This study is a retrospective observational study with a pre-post design. The research subjects were chronic hepatitis C patients who had 12 weeks after end of DAA therapy at the Internal Medicine Polyclinic, Dr. Sardjito General Hospital, Yogyakarta. Liver stiffness status was assessed before treatment and at SVR12, based on APRI scores and transient elastography values. Results. There were 49 research subjects. The mean age was 56.33 more less 12.08 years. Wilcoxon test analysis revealed a significant decrease in median APRI scores (1.13 to 0.38; p less than 0.001) and transient elastography values (19.45 to 14.85; p equals 0.021) from before treatment and at SVR12 post sofosbuvir daclatasvir therapy. Significant decrease before treatment and at SVR12 post sofosbuvir daclatasvir therapy, APRI score less than 1 (0.41 vs 0.25; p equal 0.004) and APRI score more than equal to 1, (1.97 vs 0.84; p less than 0.001). The increase in transient elastography less than 9.6 kPa (4.9 vs 5.0; p equal 0.893) was not statistically significant, and a significant decrease in transient elastography more than equal to 9.6 kPa (21.90 vs 17; p equal 0.023). Mann Whitney test analysis showed that the median decrease in APRI scores and transient elastography was not significant based on the variables of age (p equal 0.230 vs p equal 0.420), gender (p equal 0.580 vs p equal 0.582), quantitative HCV RNA (p equal 0.967 vs p equal 0.660). Conclusion. Direct Acting Antiviral improve liver stiffness in chronic hepatitis C patients.

Kata Kunci : Direct Acting Antiviral, chronic hepatitis C, APRI score, transient elastography