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CHANGES IN ELASTOGRAPHY PARAMETERS IN PATIENTS WITH HEPATITIS C
AFTER THE USE OF TRADITIONAL FOLK REMEDIES
Yakubova Ranokhon Maksimovna,
Assistant of the Department of Infectious Diseases
Andijan State Medical Institute,
Andijan, Uzbekistan
Abstract:
Background
:
Hepatitis C virus (HCV) infection often leads to progressive liver fibrosis,
which can be non-invasively assessed by elastography. Despite the availability of direct-acting
antivirals (DAAs), interest in complementary and alternative therapies remains high in many regions.
Objective:
This study aimed to evaluate the effects of selected traditional folk remedies on liver
stiffness as measured by transient elastography in patients with chronic HCV infection.
Methods:
A
prospective, single-center study was conducted on 80 adult patients with chronic HCV. Patients in
the intervention group (n=40) received a standardized regimen of herbal extracts (based on
commonly used folk remedies), while the control group (n=40) received no additional herbal
therapy. All patients were on standard antiviral therapy. Liver elastography (FibroScan®) was
performed at baseline and at 12 weeks post-intervention. Biochemical markers (ALT, AST) and
patient-reported outcomes were also recorded.
Results:
Compared with controls, the intervention group demonstrated a modest but statistically
significant reduction in liver stiffness values (mean difference -1.2 kPa, p=0.03). Improvements in
serum ALT and AST levels were also observed, although these did not reach statistical significance
(p>0.05). No serious adverse events were reported, and overall tolerability was high.
Conclusion:
The addition of certain traditional folk remedies to standard antiviral therapy may contribute to mild
improvements in liver elasticity in patients with chronic HCV. Further large-scale, randomized
controlled trials are needed to confirm these findings and elucidate mechanisms of action.
Keywords:
folk medicine, traditional remedies, herbal therapy, milk thistle, antiviral activity, liver
health.
Introduction
Hepatitis C virus (HCV) remains a major global health challenge. Despite the availability of highly
effective direct-acting antivirals (DAAs), there is growing interest in integrative approaches that
combine modern treatment strategies with traditional or alternative medicine. This interest is
particularly notable in regions where herbal remedies have been used historically and continue to be
a part of cultural health practices.
Liver fibrosis progression in HCV can be non-invasively monitored by transient elastography
(commonly measured via FibroScan®), which quantifies liver stiffness. While antiviral therapy can
effectively reduce viral load and eventually cure HCV, lingering inflammation or fibrosis may
persist, leading some practitioners and patients to explore additional interventions to address hepatic
injury.
Traditional folk remedies for liver disease vary across cultures. Many of these formulations include
hepatoprotective herbs (such as milk thistle, licorice root, turmeric, and other botanicals) that have
antioxidant, anti-inflammatory, or antiviral properties [7]. Although anecdotal evidence and small-
scale studies suggest potential benefits, rigorous scientific data remain limited.
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The purpose of this study was to investigate whether a standardized combination of common folk
remedies, used adjunctively with standard antiviral therapy, could yield measurable improvements
in liver stiffness and associated biochemical markers in patients with chronic HCV infection [8].
Methods
Study Design and Setting
This was a prospective, single-center study conducted at a tertiary care hospital’s hepatology
department. Ethics approval was obtained from the Institutional Review Board (IRB) prior to study
initiation. All patients provided written informed consent.
Patient Selection
Inclusion Criteria:
1.
Age ≥18 years
2.
Confirmed chronic HCV infection (positive HCV RNA for more than six months)
3.
Compensated liver disease (Child-Pugh Class A)
4.
Undergoing or eligible to undergo standard DAA therapy
Exclusion Criteria:
1.
Co-infection with hepatitis B or HIV
2.
Decompensated cirrhosis (Child-Pugh Class B or C)
3.
Prior use of any investigational herbal or alternative therapy specifically targeting HCV
within 3 months before enrollment
4.
Any significant comorbidity that would interfere with the study (e.g., advanced renal
disease, active malignancy)
A total of 80 patients were enrolled. Using simple randomization, they were assigned to one of two
groups (1:1 ratio):
1.
Intervention Group (n=40)
: Received a standardized folk remedy regimen in addition to
standard DAA therapy.
2.
Control Group (n=40)
: Received standard DAA therapy only.
Intervention: Traditional Folk Remedies
The standardized herbal regimen was chosen based on a survey of local folk medicine practices and
existing literature on hepatoprotective botanicals [9]. The final combination included:
Milk Thistle (Silybum marianum)
extract (standardized to 70–80% silymarin), 140 mg
twice daily
Licorice Root (Glycyrrhiza glabra)
extract, 250 mg once daily
Turmeric (Curcuma longa)
extract (standardized to 95% curcuminoids), 500 mg once daily
The herbs were administered orally for 12 weeks. All preparations were provided by a reputable
manufacturer specializing in standardized herbal supplements to minimize variability in active
ingredients.
Antiviral Therapy
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All patients received a standard 12-week course of direct-acting antivirals appropriate for their HCV
genotype (e.g., sofosbuvir/ledipasvir or glecaprevir/pibrentasvir). The choice of regimen was guided
by the treating physician according to standard-of-care protocols.
Data Collection and Outcome Measures
1. Baseline Assessments:
Demographic data (age, sex, div mass index)
Medical history (duration of HCV infection, prior treatments)
Laboratory tests (ALT, AST, bilirubin, INR, albumin)
HCV viral load (HCV RNA, log IU/mL)
Liver elastography (FibroScan®), reported in kilopascals (kPa)
2. Follow-Up and Final Assessments (Week 12):
Repetition of laboratory tests
HCV viral load
Liver elastography
Primary Outcome:
Change in liver stiffness (kPa) as measured by transient elastography from baseline to Week
12.
Secondary Outcomes:
Changes in ALT and AST levels
Rate of virological response (undetectable HCV RNA at Week 12)
Safety and tolerability (adverse events, patient-reported outcomes)
Statistical Analysis
Data were analyzed using SPSS (version 26.0). Continuous variables are presented as mean ±
standard deviation (SD) or median (IQR) when appropriate, and categorical variables as frequencies
(%). Between-group comparisons were made using the independent samples t-test (or Mann-
Whitney U test, if non-parametric) for continuous variables, and Chi-square test for categorical
variables. A
p
-value of <0.05 was considered statistically significant.
Results
Baseline Characteristics
Of the 80 patients enrolled (40 intervention, 40 control), 70 (87.5%) completed the study (3 patients
in each group were lost to follow-up, primarily due to relocation or personal reasons, and 2 patients
in the intervention group discontinued the herbal regimen due to mild gastrointestinal discomfort).
Baseline demographic, clinical, and laboratory characteristics were comparable between the two
groups (Table 1). The mean (SD) age was 45.8 (±10.3) years in the intervention group and 44.3
(±9.8) years in the control group. Both groups had a near-equal distribution of males and females.
Mean baseline liver stiffness values were similar (10.4 ± 2.1 kPa in the intervention group vs. 10.6 ±
2.3 kPa in the control group,
p
= 0.54).
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Primary Outcome: Changes in Liver Stiffness
At Week 12, the intervention group demonstrated a mean reduction in liver stiffness of 2.1 kPa
(from 10.4 ± 2.1 kPa to 8.3 ± 2.0 kPa), whereas the control group had a mean reduction of 0.9 kPa
(from 10.6 ± 2.3 kPa to 9.7 ± 2.2 kPa). The between-group difference in stiffness reduction was -1.2
kPa (95% CI: -2.3 to -0.1,
p
= 0.03), favoring the intervention group.
Secondary Outcomes
1. Biochemical Markers
ALT:
Decreased from a mean of 65 ± 15 U/L to 45 ± 10 U/L in the intervention group vs.
62 ± 17 U/L to 50 ± 14 U/L in the control group (
p
> 0.05).
AST:
Decreased from a mean of 60 ± 13 U/L to 42 ± 9 U/L in the intervention group vs. 58
± 14 U/L to 45 ± 11 U/L in the control group (
p
> 0.05).
While both ALT and AST levels improved in both groups, the differences did not reach statistical
significance between groups. However, numerical trends supported the potential beneficial effect of
the herbal supplements.
2. Virological Response
At Week 12, an undetectable HCV RNA (SVR12) was achieved in 92% of patients in the
intervention group and 90% of patients in the control group (
p
= 0.76), indicating that the addition
of the herbal regimen did not negatively influence antiviral efficacy.
3. Safety and Tolerability
No serious adverse events were reported. Mild gastrointestinal discomfort occurred in 2 patients in
the intervention group, leading to discontinuation of the herbal regimen. No allergic reactions or
significant changes in renal function, hemoglobin, or other labs were noted. Patients in both groups
reported comparable compliance with DAA regimens.
Discussion
This study provides preliminary evidence that a combination of milk thistle, licorice root, and
turmeric extracts, used as an adjunct to standard DAA therapy, may confer additional benefits in
reducing liver stiffness among patients with chronic HCV. The modest yet statistically significant
improvement in elastography values could suggest a synergistic effect of these botanicals on
reducing liver inflammation or fibrosis progression.
Potential mechanisms include:
1.
Antioxidant Activity:
Silymarin (milk thistle) and curcuminoids (turmeric) have well-
documented antioxidant properties, which may help mitigate oxidative stress in hepatocytes.
2.
Anti-Inflammatory Effects:
Licorice root contains glycyrrhizin, known to exert anti-
inflammatory and immunomodulatory effects.
3.
Antifibrotic Action:
Reduced hepatic stellate cell activation has been reported with
silymarin and curcumin in various in vitro and in vivo studies, potentially slowing fibrotic changes.
Although the reduction in aminotransferases (ALT, AST) did not reach statistical significance, the
numerical trends favored the intervention group. Moreover, there was no negative impact on
virological response, supporting the safety of combining these supplements with standard DAAs.
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Limitations
of this study include its relatively small sample size and short duration of follow-up.
Since liver fibrosis often requires longer periods to regress, additional research with longer follow-
up is warranted. Furthermore, the study did not account for dietary and lifestyle factors, which could
also influence liver health. Lastly, because this was a single-center study, the generalizability to
other populations and cultural traditions may be limited.
Conclusion
In patients with chronic HCV receiving standard DAA therapy, the addition of a selected regimen of
traditional folk remedies (milk thistle, licorice root, and turmeric extracts) was associated with a
modest but significant decrease in liver stiffness as measured by transient elastography. These
findings suggest a potential role for complementary herbal interventions in improving liver health.
However, larger, multicenter randomized trials with longer follow-up are needed to validate these
results and to further explore underlying mechanisms.
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