Noninvasive Fibrosis Assessment in Chronic Hepatitis C Infection: An Update

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Abstract

Liver biopsy is historically the gold standard for liver fibrosis assessment of chronic hepatitis C patients. However, with the introduction and validation of noninvasive tests (NITs) to evaluate advanced fibrosis, and the direct-acting antiviral agents for treatment of chronic hepatitis C virus (HCV), the role of NITs have become even more complex. There is now need for longitudinal monitoring and elucidation of cutoff values for prediction of liver-related complication after sustained virological response. The aim of this report is to provide a critical overview of the various NITs available for the assessment of liver fibrosis in HCV patients.

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Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection.

Richard Sterling, Eduardo Lissen, Nathan Clumeck … (2006)

Liver biopsy remains the gold standard in the assessment of severity of liver disease. Noninvasive tests have gained popularity to predict histology in view of the associated risks of biopsy. However, many models include tests not readily available, and there are limited data from patients with HIV/hepatitis C virus (HCV) coinfection. We aimed to develop a model using routine tests to predict liver fibrosis in patients with HIV/HCV coinfection. A retrospective analysis of liver histology was performed in 832 patients. Liver fibrosis was assessed via Ishak score; patients were categorized as 0-1, 2-3, or 4-6 and were randomly assigned to training (n = 555) or validation (n = 277) sets. Multivariate logistic regression analysis revealed that platelet count (PLT), age, AST, and INR were significantly associated with fibrosis. Additional analysis revealed PLT, age, AST, and ALT as an alternative model. Based on this, a simple index (FIB-4) was developed: age ([yr] x AST [U/L]) / ((PLT [10(9)/L]) x (ALT [U/L])(1/2)). The AUROC of the index was 0.765 for differentiation between Ishak stage 0-3 and 4-6. At a cutoff of 3.25 had a positive predictive value of 65% and a specificity of 97%. Using these cutoffs, 87% of the 198 patients with FIB-4 values outside 1.45-3.25 would be correctly classified, and liver biopsy could be avoided in 71% of the validation group. In conclusion, noninvasive tests can accurately predict hepatic fibrosis and may reduce the need for liver biopsy in the majority of HIV/HCV-coinfected patients.

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Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension.

Roberto de Franchis (2015)

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Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study

Sarah Blach, Stefan Zeuzem, Michael Manns … (2017)

The 69th World Health Assembly approved the Global Health Sector Strategy to eliminate hepatitis C virus (HCV) infection by 2030, which can become a reality with the recent launch of direct acting antiviral therapies. Reliable disease burden estimates are required for national strategies. This analysis estimates the global prevalence of viraemic HCV at the end of 2015, an update of-and expansion on-the 2014 analysis, which reported 80 million (95% CI 64-103) viraemic infections in 2013.

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Journal

Journal ID (nlm-ta): J Clin Transl Hepatol

Journal ID (iso-abbrev): J Clin Transl Hepatol

Journal ID (publisher-id): JCTH

Title: Journal of Clinical and Translational Hepatology

Publisher: XIA & HE Publishing Inc.

ISSN (Print): 2225-0719

ISSN (Electronic): 2310-8819

Publication date (Print): 28 October 2023

Publication date (Electronic): 11 May 2023

Volume: 11

Issue: 5

Pages: 1228-1238

Affiliations

[1 ]Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia

[2 ]Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia

[3 ]Health Center Osijek-Baranja County, Osijek, Croatia

[4 ]Department of Biology, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia

[5 ]University Hospital Dubrava, Zagreb, Croatia

[6 ]School of Medicine, University of Zagreb, Zagreb, Croatia

[7 ]Microbial Biotechnology Department, Biotechnology Research Institute, National Research Center, Giza, Egypt

[8 ]Egypt Center for Research and Regenerative Medicine (ECRRM), Cairo, Egypt

[9 ]University of Connecticut Health Center, Farmington, CT, USA

Author notes

[* ] Correspondence to: Robert Smolic, Department of Pharmacology and Biochemistry, Faculty of Dental Medicine and Health Osijek, Crkvena ulica 21, HR-31000 Osijek, Croatia. ORCID: https://orcid.org/0000-0003-4614-4344. Tel: +385-31399600, Fax: +385-31399601, E-mail: robert.smolic@ 123456fdmz.hr

This research received no external funding. The article processing charge was funded by the grant from the Croatian Ministry of Science and Education dedicated to multiyear institutional funding of scientific activity at the Josip Juraj Strossmayer University of Osijek, Faculty of Dental Medicine and Health Osijek, Croatia – grant number IP7-FDMZ-2020 (to MS).

GW has been an editor-in-chief of Journal of Clinical and Translational Hepatology since 2013. MS and RS have been editorial board members of Journal of Clinical and Translational Hepatology since 2013. The other authors have no conflict of interests related to this publication.

Conceptualization (KB, MSB, MS), methodology (GI) formal analysis (RS), investigation (KB, MSB), data curation (KB, MSB, RS, SV), writing - original draft preparation (KB, MSB), writing - review and editing (MS, RS, SV, AT, GW), visualization (RS), supervision (KB, MS), project administration (MS), funding acquisition (MS). All authors have read and agreed to the published version of the manuscript.

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Robert Smolic https://orcid.org/0000-0003-4614-4344

Article

Publisher ID: JCTH.2022.00365

DOI: 10.14218/JCTH.2022.00365

PMC ID: 10412701

PubMed ID: 37577224

SO-VID: 1270ddce-986b-49f2-a43b-32e75ec37d45

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 4.0 International License (CC BY-NC 4.0), permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 29 July 2022

Date revision received : 4 November 2022

Date accepted : 27 February 2023

Noninvasive Fibrosis Assessment in Chronic Hepatitis C Infection: An Update

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Decoding Infection and Transmission

Most cited references 118

Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection.

Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension.

Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study

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