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Shahriar S, Araf Y, Ahmad R, Kattel P, Sah GS, Rahaman TI, Sadiea RZ, Sultana S, Islam MS, Zheng C, Hossain MG. Insights Into the Coinfections of Human Immunodeficiency Virus-Hepatitis B Virus, Human Immunodeficiency Virus-Hepatitis C Virus, and Hepatitis B Virus-Hepatitis C Virus: Prevalence, Risk Factors, Pathogenesis, Diagnosis, and Treatment. Front Microbiol 2022; 12:780887. [PMID: 35222296 PMCID: PMC8865087 DOI: 10.3389/fmicb.2021.780887] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/21/2021] [Indexed: 12/15/2022] Open
Abstract
Human immunodeficiency virus, hepatitis B virus, and hepatitis C virus are three blood-borne viruses that can cause major global health issues by increasing severe morbidity. There is a high risk of coinfection with these viruses in individuals because of their same transmission routes through blood using shared needles, syringes, other injection equipment, sexual transmission, or even vertical transmission. Coinfection can cause various liver-related illnesses, non-hepatic organ dysfunction, followed by death compared to any of these single infections. The treatment of coinfected patients is complicated due to the side effects of antiviral medication, resulting in drug resistance, hepatotoxicity, and a lack of required responses. On the other hand, coinfected individuals must be treated with multiple drugs simultaneously, such as for HIV either along with HBV or HCV and HBV and HCV. Therefore, diagnosing, treating, and controlling dual infections with HIV, HBV, or HCV is complicated and needs further investigation. This review focuses on the current prevalence, risk factors, and pathogenesis of dual infections with HIV, HBV, and HCV. We also briefly overviewed the diagnosis and treatment of coinfections of these three blood-borne viruses.
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Affiliation(s)
- Sagarika Shahriar
- Biotechnology Program, Department of Mathematics and Natural Sciences, BRAC University, Dhaka, Bangladesh
| | - Yusha Araf
- Department of Genetic Engineering and Biotechnology, School of Life Sciences, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Rasel Ahmad
- Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Pravakar Kattel
- Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Ganga Sagar Sah
- Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Tanjim Ishraq Rahaman
- Department of Biotechnology and Genetic Engineering, Faculty of Life Sciences, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj, Bangladesh
| | - Rahila Zannat Sadiea
- Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Shahnaj Sultana
- Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Md. Sayeedul Islam
- Department of Biological Sciences, Graduate School of Science, Osaka University, Osaka, Japan
| | - Chunfu Zheng
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB, Canada
| | - Md. Golzar Hossain
- Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh, Bangladesh
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García-Compeán D, Villarreal-Pérez JZ, Cavazos MEDLO, Lavalle-Gonzalez FJ, Borjas-Almaguer OD, Del Cueto-Aguilera AN, González-González JA, Treviño-Garza C, Huerta-Pérez L, Maldonado-Garza HJ. Prevalence of liver fibrosis in an unselected general population with high prevalence of obesity and diabetes mellitus. Time for screening? Ann Hepatol 2020; 19:258-264. [PMID: 32063504 DOI: 10.1016/j.aohep.2020.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/31/2019] [Accepted: 01/14/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Cirrhosis and liver cancer are currently common causes of death worldwide. The global epidemic of obesity has increased the incidence of nonalcoholic fatty liver disease (NAFLD) and cirrhosis in recent years. Advanced fibrosis increases the morbimortality rate in NAFLD. The Mexican population has one of the highest prevalence of obesity and diabetes mellitus (DM) worldwide. AIM To determine the prevalence of advanced liver fibrosis in Mexican general population. METHODS Adult individuals, without a history of liver disease nor heavy alcohol consumption were randomly sampled from 20,919 participants of a health and nutrition survey applied to the general population. Clinical and laboratory evaluations were performed to calculate the NAFLD fibrosis score (NFS) (an extensively validated non-invasive method). Two cut-off points were used. Advanced fibrosis was defined as a result >0.676. RESULTS In total 695 individuals were included. The mean age was 47.8±16.4. The majority were between 20 and 50 years (59%), 70.2% were female, 35.5% showed obesity and 15.8% DM. The 93% had normal serum ALT. Based on the NFS results, 56 individuals (8.1%) had a high probability of fibrosis. Most patients from this subgroup showed normal serum ALT (92.9%), 89.3% were >45yr. old, 52% were obese and 27% suffered from DM. CONCLUSIONS Based on these results, 8.1% of Mexican general population without a history of liver disease is at high risk of having advanced liver fibrosis and complications and death derived from cardiovascular disease and cirrhosis. Most of them showed normal ALT serum levels.
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Affiliation(s)
- Diego García-Compeán
- Gastroenterology Service, Internal Medicine Department, University Hospital and Faculty of Medicine, Autonomous University of Nuevo León, Monterrey, N.L., Mexico.
| | - Jesús Zacarías Villarreal-Pérez
- Endocrinology Service, Internal Medicine Department, University Hospital and Faculty of Medicine, Autonomous University of Nuevo León, Monterrey, N.L., Mexico
| | - Manuel Enrique de la O Cavazos
- Department of Pediatric, University Hospital and Faculty of Medicine, Autonomous University of Nuevo León, Monterrey, N.L., Mexico; Ministry of Health of the Government of the State of Nuevo León, Monterrey, N.L., Mexico
| | - Fernando Javier Lavalle-Gonzalez
- Endocrinology Service, Internal Medicine Department, University Hospital and Faculty of Medicine, Autonomous University of Nuevo León, Monterrey, N.L., Mexico
| | - Omar David Borjas-Almaguer
- Gastroenterology Service, Internal Medicine Department, University Hospital and Faculty of Medicine, Autonomous University of Nuevo León, Monterrey, N.L., Mexico
| | - Angel Noé Del Cueto-Aguilera
- Gastroenterology Service, Internal Medicine Department, University Hospital and Faculty of Medicine, Autonomous University of Nuevo León, Monterrey, N.L., Mexico
| | - José Alberto González-González
- Gastroenterology Service, Internal Medicine Department, University Hospital and Faculty of Medicine, Autonomous University of Nuevo León, Monterrey, N.L., Mexico
| | - Consuelo Treviño-Garza
- Department of Pediatric, University Hospital and Faculty of Medicine, Autonomous University of Nuevo León, Monterrey, N.L., Mexico; Ministry of Health of the Government of the State of Nuevo León, Monterrey, N.L., Mexico
| | - Lourdes Huerta-Pérez
- Faculty of Public Health and Nutrition, Autonomous University of Nuevo León, Monterrey, N.L., Mexico; Ministry of Health of the Government of the State of Nuevo León, Monterrey, N.L., Mexico
| | - Héctor Jesús Maldonado-Garza
- Gastroenterology Service, Internal Medicine Department, University Hospital and Faculty of Medicine, Autonomous University of Nuevo León, Monterrey, N.L., Mexico
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da Silva Franco KMV, Vieira WB, Dias ARN, Falcão ASC, Falcão LFM, Quaresma JAS. Doppler ultrasonography: A non-invasive method used to diagnose and follow up patients with chronic hepatitis C. J Gastroenterol Hepatol 2020; 35:314-319. [PMID: 31335991 DOI: 10.1111/jgh.14793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/14/2019] [Accepted: 07/18/2019] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM This study aimed to investigate the association between the findings of Doppler ultrasonography and transient elastography using FibroScan and to determine the cut-off points, sensitivity, and specificity of resistance indices, and pulsatility of the hepatic vessels to predict significant hepatic fibrosis. METHODS This is a transversal, observational, and analytical study that includes 30 patients with chronic hepatitis C who were admitted at a public referral hospital. Transient elastography and ultrasonographic data were collected, and the linear association between these methods was evaluated using the Pearson test. Various Doppler velocimetric indices were compared according to the presence/absence of significant (≥ F2) fibrosis. RESULTS There was a moderate-strong linear association between the FibroScan data and the Doppler velocimetric indices and splenic index in the hepatic vessels; the mean values of the indices differed between groups with absent/mild (F0/F1) and significant (≥ F2) hepatic fibrosis. There was an association between the monophasic and biphasic wave pattern of the suprahepatic veins and the stratification of hepatic fibrosis estimated by the values of kilopascal in FibroScan. CONCLUSION Doppler ultrasonography is a non-invasive method used to evaluate liver fibrosis, and it presents acceptable sensitivity/specificity for the prediction of fibrosis ≥ F2 in patients with chronic hepatitis C.
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Affiliation(s)
| | - Waldonio Brito Vieira
- Núcleo de Medicina Tropical, Universidade Federal do Pará, Belém, Brazil.,Santa Casa de Misericórdia, Belém, Brazil
| | - Apio Ricardo Nazareth Dias
- Núcleo de Medicina Tropical, Universidade Federal do Pará, Belém, Brazil.,Universidade do Estado do Pará, Belém, Brazil
| | | | | | - Juarez Antônio Simões Quaresma
- Núcleo de Medicina Tropical, Universidade Federal do Pará, Belém, Brazil.,Universidade do Estado do Pará, Belém, Brazil.,Instituto Evandro Chagas, Belém, Brazil
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Salomon RE, Tan KR, Vaughan A, Adynski H, Muscatell KA. Minimally-invasive methods for examining biological changes in response to chronic stress: A scoping review. Int J Nurs Stud 2020; 103:103419. [PMID: 31945603 DOI: 10.1016/j.ijnurstu.2019.103419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Nurse researchers are increasingly interested in incorporating biological indicators related to chronic stress, or repeated or constant exposure to psychological stressors. Minimally invasive collection methods may improve access to vulnerable populations. OBJECTIVE To map biological indicators measured through minimally invasive methods investigating biological changes in response to chronic stress. DESIGN, DATA SOURCES, AND METHODS The paper seeks to answer two questions: What are the characteristics of the minimally-invasive methods used to measure the biological correlates of chronic stress? What are the limitations regarding the use of the minimally-invasive methods and/or biological indicators identified above? Authors completed a scoping review following guidelines from the Joanna Briggs Institute Manual and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews. A literature search was completed in PubMed, PsycINFO, and Scopus. 2518 articles were screened and 145 studies were included. Data were extracted using a standardized extraction tool, compiled, and coded. RESULTS Studies included minimally-invasive methods to measure the hypothalamic-adrenal-pituitary axis (N = 173), immune and inflammatory markers (N = 118), and adult neurogenesis (N = 6). Cortisol was most frequently measured (N = 136), usually in saliva (N = 86). Studies included a variety of limitations for the methods and indicators, including concerns about timing and accuracy of collection, frequency of sampling, and controlling for acute stressors. CONCLUSIONS Nurse researchers have access to many minimally-invasive methods to measure altered biological processes related to chronic stress. A gap identified by this review is the paucity of minimally-invasive methods for investigating neurogenesis; the measurement of brain derived neurotrophic factor in plasma is a distal proxy and further research is needed to test the response of peripheral levels to psychosocial stress interventions. Additionally, while this scoping review allows nurse researchers to consider possible biological indicators to include in their research, future research is still needed on some of the basic premises of stress research, including agreement on the conceptualization of chronic stress.
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Affiliation(s)
- Rebecca E Salomon
- School of Nursing, University of California San Francisco, 2 Koret Way, UCSF Box 0608, San Francisco, CA 94143-0608, USA.
| | - Kelly R Tan
- School of Nursing, University of California San Francisco, 2 Koret Way, UCSF Box 0608, San Francisco, CA 94143-0608, USA.
| | - Ashley Vaughan
- School of Nursing, University of California San Francisco, 2 Koret Way, UCSF Box 0608, San Francisco, CA 94143-0608, USA.
| | - Harry Adynski
- School of Nursing, University of California San Francisco, 2 Koret Way, UCSF Box 0608, San Francisco, CA 94143-0608, USA.
| | - Keely A Muscatell
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Campus Box #3270, 235 E. Cameron Avenue, Chapel Hill, NC 27599-3270, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Campus Box #7295, 450 West Drive, Chapel Hill, NC 27599-7295, USA.
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Abd El-Meguid M, Dawood RM, Mokhles MA, El Awady MK. Extrahepatic Upregulation of Transforming Growth Factor Beta 2 in HCV Genotype 4-Induced Liver Fibrosis. J Interferon Cytokine Res 2019; 38:341-347. [PMID: 30130153 DOI: 10.1089/jir.2018.0045] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Elevated levels of transforming growth factor-β (TGF-β) family mediate myofibroblast generation and extracellular matrix deposition, thus making TGF-β recognized as major profibrogenic cytokines. In this article, we provide evidence that extrahepatic TGF-β2 expression at RNA and protein levels in peripheral leucocytes and serum, respectively, correlate with hepatic fibrogenesis. Current study includes a total of 110 subjects [89 naive hepatitis C virus (HCV)-infected patients (f0-f4) and 21 healthy controls]. Array profiling of 84 fibrosis-related transcripts revealed that TGF-β2 RNA was significantly upregulated compared with controls. Transcription results were confirmed by specific qRT-PCR on TGF-β2 RNA in peripheral leucocytes and TGF-β2 protein by ELISA in serum. PCR array and qRT-PCR for TGF-β2 RNA in peripheral leucocytes revealed that HCV-infected patients, regardless of the degree of fibrosis, had significantly elevated TGF-β2 RNA levels compared with controls (P = 0.018 and 0.047, respectively). This extrahepatic upregulation of TGF-β2 RNA was confirmed by elevated levels of secretory TGF-β2 protein in infected sera (P = 0.001). The Area Under the Curve of the receiver operating characteristic curve for the TGF-β2 protein between patients and controls was 0.80, a value that renders serum TGF-β2 protein a promising biomarker for liver fibrosis.
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Affiliation(s)
- Mai Abd El-Meguid
- 1 Genetic Engineering Division, Department of Microbial Biotechnology, National Research Centre , Giza, Egypt
| | - Reham M Dawood
- 1 Genetic Engineering Division, Department of Microbial Biotechnology, National Research Centre , Giza, Egypt
| | | | - Mostafa K El Awady
- 1 Genetic Engineering Division, Department of Microbial Biotechnology, National Research Centre , Giza, Egypt
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Liu W, Li X, Zheng W, Yao R, Zheng J. Preoperative evaluation of the degree of liver fibrosis based on matter-element analysis using serological indicators in patients with hepatocellular carcinoma. Biosci Trends 2019; 13:70-76. [PMID: 30867373 DOI: 10.5582/bst.2018.01311] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Evaluation of the degree of liver fibrosis is an important basis for the clinical diagnosis and treatment of patients with hepatocellular carcinoma (HCC). It is meaningful to make a preoperative evaluation with non-invasive methods. In the current study, 12 commonly used preoperative serological indicators from 161 HCC patients with different degree of liver fibrosis were collected retrospectively, and 8 of the indicators (ALB, PA, TBil, INR, AST, GGT, ALP, and PT) were ultimately used in matter-element analysis to create a formula. The relationship between those results and the histological sub-classification of the Laennec liver fibrosis scoring system was analyzed. The calculated value of R from this formula will indicate the differing degree of liver fibrosis in a patient: i) the value of 0.802 ≤ R < 1 indicates the early stage of liver cirrhosis, which corresponds to Laennec stages 0-3; ii) the value of 0.752 ≤ R < 0.802 indicates the mild stage of liver cirrhosis, which corresponds to Laennec stage 4A; iii) the value of 0.698 ≤ R < 0.752 indicates the moderate stage of liver cirrhosis, which corresponds to Laennec stage 4B; and iv) the value of 0.444 ≤ R < 0.698 indicates the severe stage of liver cirrhosis, which corresponds to Laennec stage 4C. The hope is that this formula for preoperative evaluation of the degree of liver fibrosis using non-invasive methods would be useful in the clinical diagnosis and treatment of patients with HCC in the future.
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Affiliation(s)
- Wei Liu
- Department of Hepatopancreatobilary Surgery, The First College of Clinical Medical Sciences, Three Gorges University
| | - Xiaosong Li
- Department of Hepatopancreatobilary Surgery, The First College of Clinical Medical Sciences, Three Gorges University
| | - Weihong Zheng
- Department of Pharmacology, Medical Science College, Three Gorges University
| | - Rucheng Yao
- Department of Hepatopancreatobilary Surgery, The First College of Clinical Medical Sciences, Three Gorges University
| | - Jun Zheng
- Department of Hepatopancreatobilary Surgery, The First College of Clinical Medical Sciences, Three Gorges University
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Mohamed Z, Rwegasha J, Kim JU, Shimakawa Y, Poiteau L, Chevaliez S, Bhagani S, Taylor‐Robinson SD, Thursz MR, Mbwambo J, Lemoine M. The hepatitis C cascade of care in people who inject drugs in Dar es Salaam, Tanzania. J Viral Hepat 2018; 25:1438-1445. [PMID: 29974582 PMCID: PMC6282511 DOI: 10.1111/jvh.12966] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/09/2018] [Accepted: 05/17/2018] [Indexed: 12/29/2022]
Abstract
The World Health Organisation has recently called for hepatitis C virus (HCV) elimination and has identified people who inject drugs (PWID) as a key population to scale-up screening and linkage to care. This study reports the cascade of care for HCV in PWID attending the largest opioid substitution treatment (OST) clinic in Dar-es-Salaam, Tanzania. Between February 2011 and March 2016, HCV serology for all PWID registered at the Muhimbili National Hospital OST clinic, Dar-es-Salaam were obtained from records. In 2015, consecutive HCV-seropositive PWID were invited to undergo a clinical evaluation including epidemiological questionnaire, liver stiffness measurement (Fibroscan) and virological analysis (HCV RNA viral load and genotyping). During the study period, 1350 persons registered at the OST clinic: all had a HCV serology including 409 (30%) positive results. Among the HCV-seropositive individuals, 207 (51%) were active attenders and 153 (37%) were enrolled for clinical assessment: 141 (92%) were male, median age: 38 years (IQR 34-41), and 65 (44%) were co-infected with HIV; 116 patients (76%) had detectable HCV RNA, with genotypes 1a (68%) and 4a (32%); 21 (17%) had clinically significant fibrosis (≥F2) and 6 (5%) had cirrhosis (F4). None were offered HCV treatment. Chronic hepatitis C among PWID enrolled in the OST centre in Dar-es-Salaam is frequent, but its continuum of care is insufficient; integration of HCV diagnosis and treatment should form a part of OST intervention in PWID in Tanzania.
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Affiliation(s)
- Zameer Mohamed
- Department of HepatologyImperial College LondonSt Mary's HospitalLondonUK
| | - John Rwegasha
- Department of GastroenterologyMuhimbili National HospitalDar es SalaamTanzania
| | - Jin U. Kim
- Department of HepatologyImperial College LondonSt Mary's HospitalLondonUK
| | - Yusuke Shimakawa
- Unité d'Épidémiologie des Maladies ÉmergentesInstitut PasteurParisFrance
| | - Lila Poiteau
- Department of VirologyFrench National Reference Center for Viral Hepatitis B, C and DeltaHopital Henri MondorUniversité Paris‐EstCréteilFrance
| | - Stéphane Chevaliez
- Department of VirologyFrench National Reference Center for Viral Hepatitis B, C and DeltaHopital Henri MondorUniversité Paris‐EstCréteilFrance
| | | | | | - Mark R. Thursz
- Department of HepatologyImperial College LondonSt Mary's HospitalLondonUK
| | - Jessie Mbwambo
- Department of PsychiatryMuhimbili University of Health and Allied SciencesMuhimbili National HospitalDar es SalaamTanzania
| | - Maud Lemoine
- Department of HepatologyImperial College LondonSt Mary's HospitalLondonUK
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Golizeh M, Melendez-Pena CE, Ward BJ, Saeed S, Santamaria C, Conway B, Cooper C, Klein MB, Ndao M. Proteomic fingerprinting in HIV/HCV co-infection reveals serum biomarkers for the diagnosis of fibrosis staging. PLoS One 2018; 13:e0195148. [PMID: 29608613 PMCID: PMC5880398 DOI: 10.1371/journal.pone.0195148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 03/16/2018] [Indexed: 12/18/2022] Open
Abstract
Background Hepatic complications of hepatitis C virus (HCV), including fibrosis and cirrhosis are accelerated in human immunodeficiency virus (HIV)-infected individuals. Although, liver biopsy remains the gold standard for staging HCV-associated liver disease, this test can result in serious complications and is subject to sampling errors. These challenges have prompted a search for non-invasive methods for liver fibrosis staging. To this end, we compared serum proteome profiles at different stages of fibrosis in HIV/HCV co- and HCV mono-infected patients using surface-enhanced laser desorption ionization time-of-flight mass spectrometry (SELDI-TOF MS). Methods Sera from 83 HIV/HCV co- and 68 HCV mono-infected subjects in 4 stages of fibrosis were tested. Sera were fractionated, randomly applied to protein chip arrays (IMAC, CM10 and H50) and spectra were generated at low and high laser intensities. Results Sixteen biomarkers achieved a p value < 0.01 (ROC values > 0.75 or < 0.25) predictive of fibrosis status in co-infected individuals and 14 in mono infected subjects. Five of these candidate biomarkers contributed to both mono- and co-infected subjects. Candidate diagnostic algorithms were created to distinguish between non-fibrotic and fibrotic individuals using a panel of 4 biomarker peaks. Conclusion These data suggest that SELDI MS profiling can identify diagnostic serum biomarkers for fibrosis that are both common and distinct in HIV/HCV co-infected and HCV mono-infected individuals.
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Affiliation(s)
- Makan Golizeh
- Program in Infectious Diseases and Immunity in Global Health, The Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Brian J. Ward
- Program in Infectious Diseases and Immunity in Global Health, The Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Sahar Saeed
- Program in Infectious Diseases and Immunity in Global Health, The Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Cynthia Santamaria
- Program in Infectious Diseases and Immunity in Global Health, The Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Brian Conway
- Vancouver Infectious Diseases Center, Vancouver, British Columbia, Canada
| | - Curtis Cooper
- The Ottawa Hospital-General Campus, Ottawa, Ontario, Canada
| | - Marina B. Klein
- Program in Infectious Diseases and Immunity in Global Health, The Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Momar Ndao
- Program in Infectious Diseases and Immunity in Global Health, The Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
- Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
- National Reference Centre for Parasitology, The Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- * E-mail:
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Enache EL, Sin A, Enache LS, Bancu L. Triplex High-Resolution Melting Assay for the Simultaneous Assessment of IFNL3 rs12979860, ABCB11 rs2287622, and RNF7 rs16851720 Genotypes in Chronic Hepatitis C Patients. J Mol Diagn 2017; 19:857-869. [PMID: 28860020 DOI: 10.1016/j.jmoldx.2017.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/14/2017] [Accepted: 07/27/2017] [Indexed: 02/07/2023] Open
Abstract
Chronic hepatitis C (CHC) is a leading cause of liver disease. Despite the improved efficacy of new antivirals, their high costs preclude their adoption in resource-limited settings, where CHC prevalence is highest. We developed a triplex high-resolution melting assay for the simultaneous assessment of three genetic polymorphisms related to the response to treatment and development of advanced fibrosis in CHC: IFNL3 rs12979860, ABCB11 rs2287622, and RNF7 rs16851720. We validated the assay in clinical samples from 130 CHC patients treated with classic therapy. The assay showed excellent reproducibility and 100% accuracy, sensitivity, and specificity against the gold standard Sanger sequencing. When added to routine examination data, genotype information significantly improved their performance for prediction of advanced liver fibrosis and sustained virological response (P = 0.041 and P = 0.011, respectively). Correspondingly, the full models had area under the receiver operating characteristic curve values of 0.842 (95% CI, 0.773-0.911) and 0.921 (95% CI, 0.870-0.972) and integrated discrimination improvements of 7.5% (95% CI, 2.5%-12.5%; P = 0.003) and 11.5% (95% CI, 5.8%-17.2%; P < 0.001), respectively. This is the first report on a diagnostic test for simultaneous genotyping of IFNL3, ABCB11, and RNF7 in CHC patients. Reliable and inexpensive, the assay should provide useful information for the clinical management of CHC, like identification of patients at risk of rapid disease progression or with high chances of response to classic therapy.
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Affiliation(s)
- Elena L Enache
- Department of Cell and Molecular Biology, University of Medicine and Pharmacy Tirgu Mures, Tirgu Mures
| | - Anca Sin
- Department of Cell and Molecular Biology, University of Medicine and Pharmacy Tirgu Mures, Tirgu Mures; Pathology Department, Emergency County Clinical Hospital Tirgu Mures, Tirgu Mures, Romania
| | - Liviu S Enache
- Department of Cell and Molecular Biology, University of Medicine and Pharmacy Tirgu Mures, Tirgu Mures; Clinical Laboratory, Emergency County Clinical Hospital Tirgu Mures, Tirgu Mures, Romania.
| | - Ligia Bancu
- Department of Internal Medicine 2, University of Medicine and Pharmacy Tirgu Mures, Tirgu Mures; Internal Medicine Department 2, Emergency County Clinical Hospital Tirgu Mures, Tirgu Mures, Romania
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10
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Cheng JC, Tseng CP, Liao MH, Peng CY, Yu JS, Chuang PH, Huang JT, Chen JJW. Activation of hepatic stellate cells by the ubiquitin C-terminal hydrolase 1 protein secreted from hepatitis C virus-infected hepatocytes. Sci Rep 2017; 7:4448. [PMID: 28667290 PMCID: PMC5493679 DOI: 10.1038/s41598-017-04259-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/11/2017] [Indexed: 12/17/2022] Open
Abstract
Hepatitis C virus (HCV) infection of hepatocytes promotes liver fibrosis by activation of hepatic stellate cells (HSCs) and excessive deposition of extracellular matrix in liver tissue. Whether or not host factors released from the HCV-infected hepatocytes play role in HSCs activation is unclear. In this study, HSCs were activated by the conditioned medium derived from HCV replicon cells. Secretomic profiling of HCV replicon cells and the parental Huh7 cells revealed ubiquitin carboxy-terminal hydrolase L1 (UCHL1) as a novel secreted protein from HCV-infected hepatocytes. UCHL1 expression in hepatocytes was induced by HCV infection. UCHL1 was expressed in the liver and found in the plasma of patients with chronic hepatitis C. Molecular analysis by use of the anti-UCHL1 neutralization antibody and purified UCHL1 protein showed that secreted UCHL1 protein was bound to the cell surface of HSCs and activated JNK signaling leading to overexpression of alpha-smooth muscle actin and the activation of HSCs. These results provide further for understanding the underlying mechanism in HCV-mediated hepatic fibrogenesis.
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Affiliation(s)
- Ju-Chien Cheng
- Department of Medical Laboratory Science and Biotechnology, China Medical University, Taichung, 40402, Taiwan.
| | - Ching-Ping Tseng
- Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, 33302, Taiwan.,Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan.,Molecular Medicine Research Center, Chang Gung University, Taoyuan, 33302, Taiwan.,Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan, 33302, Taiwan
| | - Mei-Huei Liao
- Department of Medical Laboratory Science and Biotechnology, China Medical University, Taichung, 40402, Taiwan.,Institute of Biomedical Sciences, National Chung Hsing University, Taichung, 40402, Taiwan
| | - Cheng-Yuan Peng
- Department of Internal Medicine, China Medical University Hospital, Taichung, 40402, Taiwan
| | - Jau-Song Yu
- Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan.,Molecular Medicine Research Center, Chang Gung University, Taoyuan, 33302, Taiwan.,Liver Research Center, Chang Gung Memorial Hospital, Linkou, 33302, Taiwan
| | - Po-Heng Chuang
- Department of Internal Medicine, China Medical University Hospital, Taichung, 40402, Taiwan
| | - Jing-Tang Huang
- Department of Medical Laboratory Science and Biotechnology, China Medical University, Taichung, 40402, Taiwan
| | - Jeremy J W Chen
- Institute of Biomedical Sciences, National Chung Hsing University, Taichung, 40402, Taiwan
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11
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Moustafa EF, Makhlouf N, Hassany SM, Helmy A, Nasr A, Othman M, Seif H, Darwish M, Hassan H, Hessen M. Non-invasive assessment of liver fibrosis in patients with hepatitis C: Shear wave elastography and colour Doppler velocity profile technique versus liver biopsy. Arab J Gastroenterol 2017; 18:6-12. [DOI: 10.1016/j.ajg.2017.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 12/20/2016] [Accepted: 01/21/2017] [Indexed: 12/29/2022]
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12
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Alavian SM, Hajarizadeh B, Bagheri Lankarani K, Sharafi H, Ebrahimi Daryani N, Merat S, Mohraz M, Mardani M, Fattahi MR, Poustchi H, Nikbin M, Nabavi M, Adibi P, Ziaee M, Behnava B, Rezaee-Zavareh MS, Colombo M, Massoumi H, Bizri AR, Eghtesad B, Amiri M, Namvar A, Hesamizadeh K, Malekzadeh R. Recommendations for the Clinical Management of Hepatitis C in Iran: A Consensus-Based National Guideline. HEPATITIS MONTHLY 2016; 16:e40959. [PMID: 27799966 PMCID: PMC5075356 DOI: 10.5812/hepatmon.guideline] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 07/31/2016] [Indexed: 02/07/2023]
Abstract
CONTEXT Hepatitis C virus (HCV) infection is a major public health issue worldwide, including Iran. The new direct-acting antiviral agents (DAAs) with high efficacy have changed the landscape of HCV treatment. This guideline provides updated recommendations for clinical management of HCV infection in Iran. EVIDENCE ACQUISITION The recommendations of this guideline are based on international and national scientific evidences and consensus-based expert opinion. Scientific evidences were collected through a systematic review of studies that evaluated efficacy and safety of DAA regimens, using PubMed, Scopus and Web of Science. Expert opinion was based on the consensus of Iran Hepatitis Scientific Board (IHSB) in the 3rd national consensus on management of Hepatitis C in Iran, held on 22nd of July 2016. RESULTS Pegylated Interferon alpha (PegIFN), Ribavirin (RBV), Sofosbuvir (SOF), Ledipasvir (LDV) and Daclatasvir (DCV) are currently available in Iran. Pre-treatment assessments include HCV RNA level, HCV genotype and resistance testing, assessment of liver fibrosis, and underlying diseases. In HCV genotype 1 and 4, DCV/SOF and LDV/SOF are recommended. In HCV genotype 2, SOF plus RBV and in HCV genotype 3, DCV/SOF is recommended. Additional care for underlying diseases should be considered. CONCLUSIONS Affordable new HCV treatment regimens are available in Iran, providing an opportunity for HCV elimination. Recommendations provided in this current national guideline can facilitate evidence-based management of HCV infection.
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Affiliation(s)
- Seyed Moayed Alavian
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Middle East Liver Diseases (MELD) Center, Tehran, IR Iran
- Corresponding Author: Seyed Moayed Alavian, Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, IR Iran. Tel: +98-2181264070, E-mail:
| | - Behzad Hajarizadeh
- Viral Hepatitis Clinical Research Program, The Kirby Institute, The University of New South Wales (UNSW Australia), Sydney, Australia
| | | | - Heidar Sharafi
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Middle East Liver Diseases (MELD) Center, Tehran, IR Iran
| | | | - Shahin Merat
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Minoo Mohraz
- Iranian Research Center for HIV/AIDS (IRCHA), Tehran University of Medical Sciences, Tehran, IR Iran
| | - Masoud Mardani
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Mohamad Reza Fattahi
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Hossein Poustchi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mehri Nikbin
- Middle East Liver Diseases (MELD) Center, Tehran, IR Iran
| | - Mahmood Nabavi
- Department of Infectious Diseases and Tropical Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Peyman Adibi
- Department of Gastroenterology and Hepatology, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Masood Ziaee
- Hepatitis Research Center, Birjand University of Medical Sciences, Birjand, IR Iran
| | - Bita Behnava
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Middle East Liver Diseases (MELD) Center, Tehran, IR Iran
| | - Mohammad Saeid Rezaee-Zavareh
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Middle East Liver Diseases (MELD) Center, Tehran, IR Iran
- Student’s Research Committee, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Massimo Colombo
- Department of Medicine, Gastroenterology Division 1, AM and A Migliavacca Center for the Study of Liver Disease, Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Italy
| | - Hatef Massoumi
- New York Associates in Gastroenterology, Bronx, New York, USA
| | - Abdul Rahman Bizri
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Majid Amiri
- Gastroenterology and Hepatology Department, Gouin Hospital, Clichy, France
| | - Ali Namvar
- Department of Hepatitis and AIDS, Pasteur Institute of Iran, Tehran, IR Iran
| | - Khashayar Hesamizadeh
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Middle East Liver Diseases (MELD) Center, Tehran, IR Iran
| | - Reza Malekzadeh
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, IR Iran
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Bracht T, Mölleken C, Ahrens M, Poschmann G, Schlosser A, Eisenacher M, Stühler K, Meyer HE, Schmiegel WH, Holmskov U, Sorensen GL, Sitek B. Evaluation of the biomarker candidate MFAP4 for non-invasive assessment of hepatic fibrosis in hepatitis C patients. J Transl Med 2016; 14:201. [PMID: 27378383 PMCID: PMC4932744 DOI: 10.1186/s12967-016-0952-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 06/21/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The human microfibrillar-associated protein 4 (MFAP4) is located to extracellular matrix fibers and plays a role in disease-related tissue remodeling. Previously, we identified MFAP4 as a serum biomarker candidate for hepatic fibrosis and cirrhosis in hepatitis C patients. The aim of the present study was to elucidate the potential of MFAP4 as biomarker for hepatic fibrosis with a focus on the differentiation of no to moderate (F0-F2) and severe fibrosis stages and cirrhosis (F3 and F4, Desmet-Scheuer scoring system). METHODS MFAP4 levels were measured using an AlphaLISA immunoassay in a retrospective study including n = 542 hepatitis C patients. We applied a univariate logistic regression model based on MFAP4 serum levels and furthermore derived a multivariate model including also age and gender. Youden-optimal cutoffs for binary classification were determined for both models without restrictions and considering a lower limit of 80 % sensitivity (correct classification of F3 and F4), respectively. To assess the generalization error, leave-one-out cross validation (LOOCV) was performed. RESULTS MFAP4 levels were shown to differ between no to moderate fibrosis stages F0-F2 and severe stages (F3 and F4) with high statistical significance (t test on log scale, p value <2.2·10(-16)). In the LOOCV, the univariate classification resulted in 85.8 % sensitivity and 54.9 % specificity while the multivariate model yielded 81.3 % sensitivity and 61.5 % specificity (restricted approaches). CONCLUSIONS We confirmed the applicability of MFAP4 as a novel serum biomarker for assessment of hepatic fibrosis and identification of high-risk patients with severe fibrosis stages in hepatitis C. The combination of MFAP4 with existing tests might lead to a more accurate non-invasive diagnosis of hepatic fibrosis and allow a cost-effective disease management in the era of new direct acting antivirals.
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Affiliation(s)
- Thilo Bracht
- />Medizinisches Proteom-Center, Ruhr-Universität Bochum, 44801 Bochum, Germany
| | - Christian Mölleken
- />Department of Gastroenterology and Hepatology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Germany
| | - Maike Ahrens
- />Medizinisches Proteom-Center, Ruhr-Universität Bochum, 44801 Bochum, Germany
| | - Gereon Poschmann
- />Molecular Proteomics Laboratory (MPL), Biologisch-Medizinisches Forschungszentrum (BMFZ), Heinrich-Heine-Universität, Düsseldorf, Germany
| | - Anders Schlosser
- />Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Martin Eisenacher
- />Medizinisches Proteom-Center, Ruhr-Universität Bochum, 44801 Bochum, Germany
| | - Kai Stühler
- />Molecular Proteomics Laboratory (MPL), Biologisch-Medizinisches Forschungszentrum (BMFZ), Heinrich-Heine-Universität, Düsseldorf, Germany
| | - Helmut E. Meyer
- />Medizinisches Proteom-Center, Ruhr-Universität Bochum, 44801 Bochum, Germany
| | - Wolff H. Schmiegel
- />Department of Gastroenterology and Hepatology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Germany
| | - Uffe Holmskov
- />Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Grith L. Sorensen
- />Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Barbara Sitek
- />Medizinisches Proteom-Center, Ruhr-Universität Bochum, 44801 Bochum, Germany
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14
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Editorial: A New Spin on Magnetic Resonance Elastography. Am J Gastroenterol 2016; 111:834-7. [PMID: 27249983 DOI: 10.1038/ajg.2016.134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 03/07/2016] [Indexed: 12/11/2022]
Abstract
The development of hepatic fibrosis is the hallmark of liver disease progression. Identifying fibrosis across the spectrum, from early stages to cirrhosis has become a major unmet need. Newer imaging techniques that measure liver elastography (stiffness) as a surrogate of fibrosis seem to outperform serum tests. The current study compares two-dimensional (2D) gradient-recalled echo magnetic resonance elastography (MRE) to three-dimensional (3D) spin-echo echo-planar imaging MRE. 3D-SE-EPI MRE was able to image more liver volume in less time with fewer technical failures. The current study demonstrates that 3D-SE-EPI MRE appears marginally superior to 2D-GRE and may evolve into the new gold standard.
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15
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Diktas H, Karacaer Z, Özturk II, Cicek H. Comparison of relationship between histopathological, serological and biochemical parameters in patients with chronic hepatitis B infection. Postgrad Med J 2016; 92:693-696. [PMID: 27170311 DOI: 10.1136/postgradmedj-2016-134069] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 04/18/2016] [Accepted: 04/24/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To demonstrate the relationship between liver histology, alanine aminotransferase (ALT)/aspartate aminotransferase (AST) and hepatitis B virus (HBV) DNA levels based on hepatitis B e antigen (HBeAg) seropositivity status in naive patients with chronic hepatitis B (CHB). MATERIALS AND METHOD Naive patients with CHB admitted to our hospital between January 2012 and April 2014 were evaluated retrospectively. The patients were allocated into one of two groups based on HBeAg-seropositivity status. RESULTS Two hundred and fourteen patients were enrolled in the study. Of these 214 patients, 103 (48.1%) were HBeAg-positive and 111 (51.9%) were HBeAg-negative. In the HBeAg-positive group, positive correlations were found between histologic activity index (HAI) scores and ALT (t=3.3, r=0.31, p=0.001), AST (t=2.8, r=0.27, p=0.005) and HBV DNA load (t=2.5, r=0.24, p=0.014). Additionally, in this group, fibrosis scores had positive correlations with ALT (t=3.3, r=0.32, p=0.001) and AST (t=2.7, r=0.26, p=0.008). In the HBeAg-negative group, positive correlations were found between HAI scores and ALT (t=3, r=0. 28, p=0.003), AST (t=3, r=0. 28, p=0.003) and HBV DNA (t=5.3, r=0. 45, p=0). In this same group, fibrosis scores had a positive correlation with HBV DNA (t=2.2, r=0. 21, p=0.024). Multivariate logistic regression analysis showed a positive relationship between fibrosis and ALT in the HBeAg-positive group and a positive relationship between fibrosis and HBV DNA load in the HBeAg-negative group. CONCLUSIONS This study showed that HBV DNA load is an independent predictive factor for evaluating HAI and fibrosis in the HBeAg-negative group. Also, ALT is an independent predictive factor for evaluating fibrosis in the HBeAg-positive group.
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Affiliation(s)
- Husrev Diktas
- Department of Infectious Diseases and Clinical Microbiology, Tatvan Military Hospital, Bitlis, Turkey
| | - Zehra Karacaer
- Department of Infectious Diseases and Clinical Microbiology, Etimesgut Military Hospital, Ankara, Turkey
| | - I Ilker Özturk
- Department of Infectious Diseases and Clinical Microbiology, Beytepe Military Hospital, Ankara, Turkey
| | - Huseyin Cicek
- Department of Infectious Diseases and Clinical Microbiology, Etimesgut Military Hospital, Ankara, Turkey
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16
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Li C, Zhang C, Li J, Huo H, Song D. Diagnostic Accuracy of Real-Time Shear Wave Elastography for Staging of Liver Fibrosis: A Meta-Analysis. Med Sci Monit 2016; 22:1349-59. [PMID: 27102449 PMCID: PMC4844274 DOI: 10.12659/msm.895662] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The present meta-analysis, based on previous studies, was aimed to evaluate the test accuracy of real-time shear wave elastography (SWE) for the staging of liver fibrosis. MATERIAL AND METHODS A systematic search on MEDLINE, PubMed, Embase, and Google Scholar databases was conducted, and data on SWE tests and liver fibrosis staging were collected. For each cut-off stage of fibrosis (F≥2, F≥3, and F≥4), pooled results of sensitivity, specificity, and area under summary receiver operating characteristic (SROC) curve were analyzed. The study heterogeneity was evaluated by χ2 and I2 tests. I2>50% or P≤0.05 indicates there was heterogeneity, and then a random-effects model was applied. Otherwise, the fixed-effects model was used. The publication bias was evaluated using Deeks funnel plots asymmetry test and Fagan plot analysis was performed. RESULTS Finally, 934 patients from 8 published studies were included in the analysis. The pooled sensitivity and specificity of SWE for F≥2 were 85.0% (95% CI, 82-88%) and 81% (95% CI, 71-88%), respectively. The area under the SROC curve with 95% CI was presented as 0.88 (95% CI, 85-91%). The pooled sensitivity and specificity of SWE for F≥3 were 90.0% (95% CI, 83.0-95.0%) and 81.0% (95% CI, 75.0-86.0%), respectively, corresponding to an area of SROC of 0.94 (95% CI, 92-96%). The pooled sensitivity and specificity of SWE for F≥4 were 87.0% (95% CI, 80.0-92.0%) and 88.0% (95% CI, 80.0-93.0%), respectively, corresponding to an area of SROC of 0.92 (95% CI, 89-94%). CONCLUSIONS The overall accuracy of SWE is high and clinically useful for the staging of liver fibrosis. Compared to the results of meta-analyses on other tests, such as RTE, TE, and ARFI, the performance of SWE is nearly identical in accuracy for the evaluation of cirrhosis. For the evaluation of significant liver fibrosis (F≥2), the overall accuracy of SWE seems to be similar to ARFI, but more accurate than RTE and TE.
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Affiliation(s)
- Changtian Li
- Ultrasound, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Changsheng Zhang
- Anesthesia and Operation Center, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Junlai Li
- Ultrasound, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Huiping Huo
- Ultrasound, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Danfei Song
- Ultrasound, Chinese PLA General Hospital, Beijing, China (mainland)
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Tama M, Naylor P, Patel S, Altawil J, Gulati D, Antaki F, Mutchnick MG, Ehrinpreis M. Overestimate of Fibrosis by FIBROSpect® II in African Americans Complicates the Management of their Chronic Hepatitis C. J Clin Transl Hepatol 2016; 4:12-9. [PMID: 27047767 PMCID: PMC4807138 DOI: 10.14218/jcth.2015.00053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 02/02/2016] [Accepted: 02/04/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Evaluation of advanced fibrosis in patients with hepatitis C virus (HCV) infection is used to facilitate decisions on treatment strategy and to initiate additional screening measures. Unfortunately, most studies have predominately Caucasian (Cau) patients and may not be as relevant for African Americans (AA). AIMS This study specifically addresses the issue of defining minimal vs. significant fibrosis in African Americans (AA) with chronic hepatitis C (CHC) using noninvasive assays. METHODS All patients (n = 319) seen between 1 January 2008 and 30 June 2013 for whom a FibroSpect II® (FSII) assay was performed and had data for calculation of aspartate aminotransferase (AST) platelet ratio index (APRI) and Fibrosis-4 (FIB-4) were identified using the medical records. RESULTS When liver biopsy score and FSII assay results for the AA patients with CHC were compared, 31% of AA had advanced FSII fibrosis scores (F2-F4) despite a biopsy score of F0-F1. In contrast, 10% of Cau over-scored. The AA false positive rate was 14% for APRI and 34% for FIB-4. Combining FSII with either APRI (7% false positive) or FIB-4 (10% false positive) improved the false positive rate in AA to 7% (FSII + APRI) and 10% (FSII + FIB-4) but reduced the sensitivity for significant fibrosis. CONCLUSIONS The FSII assay overestimates fibrosis in AA and should be used with caution since these patients may not have significant fibrosis. If the APRI or FIB-4 assay is combined with the FSII assay, minimal fibrosis in AA can be defined without subjecting the patients to a subsequent biopsy.
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Affiliation(s)
- Maher Tama
- Wayne State University School of Medicine, Department of Internal Medicine, Division of Gastroenterology, Detroit, MI, USA
| | - Paul Naylor
- Wayne State University School of Medicine, Department of Internal Medicine, Division of Gastroenterology, Detroit, MI, USA
- Correspondence to: Paul Naylor, Gastroenterology, 603 Hudson Bldg, Harper University Hospital, 3990 John R, Detroit, MI 48201, USA. Tel: +1-313-745-8601, Fax: +1-313-745-8843, E-mail:
| | - Suhag Patel
- Wayne State University School of Medicine, Department of Internal Medicine, Division of Gastroenterology, Detroit, MI, USA
| | - Johnny Altawil
- Wayne State University School of Medicine, Department of Internal Medicine, Division of Gastroenterology, Detroit, MI, USA
| | - Dhiraj Gulati
- Wayne State University School of Medicine, Department of Internal Medicine, Division of Gastroenterology, Detroit, MI, USA
| | - Fadi Antaki
- Wayne State University School of Medicine, Department of Internal Medicine, Division of Gastroenterology, Detroit, MI, USA
| | - Milton G. Mutchnick
- Wayne State University School of Medicine, Department of Internal Medicine, Division of Gastroenterology, Detroit, MI, USA
| | - Murray Ehrinpreis
- Wayne State University School of Medicine, Department of Internal Medicine, Division of Gastroenterology, Detroit, MI, USA
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Eminler AT, Uslan MI, Ayyildiz T, Irak K, Kiyici M, Gurel S, Dolar E, Gulten M, Nak SG. Mean platelet volume is an important predictor of hepatitis C but not hepatitis B liver damage. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2016; 20:865-70. [PMID: 26759574 PMCID: PMC4696372 DOI: 10.4103/1735-1995.170609] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND The mean platelet volume (MPV) is the most commonly used measure of platelet size and is a potential marker of platelet reactivity. In this study, we aimed to explore the relationship between hepatic histopathology in viral hepatitis and MPV levels, which are associated with platelet count and activity. MATERIALS AND METHODS We performed a retrospective case-control study of baseline histological and clinical parameters in chronic hepatitis B and C patients in our tertiary reference center between January 2005 and January 2011. Two hundred and five chronic hepatitis B patients and 133 chronic hepatitis C patients who underwent liver biopsy were included in the study. The patients were divided into two groups: Chronic hepatitis B and chronic hepatitis C and were additionally divided into groups of two according to histological activity index (HAI) and fibrosis scores obtained by liver biopsy results (according to the Ishak scoring system). The clinical characteristics of chronic viral hepatitis patients, including demographics, laboratory (especially MPV), and liver biopsy findings, were reviewed. RESULTS One hundred and forty-three patients were male (69.1%), and the mean age was 41.9 ± 12.75 with an age range of 18-71 years in hepatitis B patients. In the classification made according to HAI, 181 patients were in the low activity group (88.3%) and 24 in the high activity group (11.7%). In the evaluation made according to fibrosis score, 169 patients were found to have early fibrosis (82.4%) and 36 were found to have advanced fibrosis (17.6%). In patients with hepatitis B, there was no statistically significant difference in terms of their MPV values between the two groups, separated according to their degree of activity and fibrosis. Sixty-three patients were male (47.3%), and the mean age was 50.03 ± 12.75 with an age range of 19-75 years. In the classification made according to HAI, 109 patients were in low activity group (81.9%) and 24 in high activity group (18.1%). In the evaluation made according to fibrosis score, 101 patients were found to have early fibrosis (75.9%) and 32 have advanced fibrosis (24.1%). There was a statistically significant difference between the activity and fibrosis groups of the hepatitis C patients (P = 0.04 and P = 0.02, respectively). CONCLUSION MPV values are more reliable in hepatitis C patients than hepatitis B for predicting the advanced damage in liver histology. This finding might be useful for the detection of early fibrosis and also starting early treatment, which is important in hepatitis C.
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Affiliation(s)
- Ahmet Tarik Eminler
- Department of Gastroenterology, Sakarya University, Adapazarı, Sakarya, Turkey
| | - Mustafa Ihsan Uslan
- Department of Gastroenterology, Sakarya University, Adapazarı, Sakarya, Turkey
| | - Talat Ayyildiz
- Department of Gastroenterology, Ondokuz Mayis University, Samsun, Turkey
| | - Kader Irak
- Department of Gastroenterology, Uludag University, Bursa, Turkey
| | - Murat Kiyici
- Department of Gastroenterology, Uludag University, Bursa, Turkey
| | - Selim Gurel
- Department of Gastroenterology, Uludag University, Bursa, Turkey
| | - Enver Dolar
- Department of Gastroenterology, Uludag University, Bursa, Turkey
| | - Macit Gulten
- Department of Gastroenterology, Uludag University, Bursa, Turkey
| | - Selim Giray Nak
- Department of Gastroenterology, Uludag University, Bursa, Turkey
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Bello DD, Ita-Nagy F, Hand J, Dieterich D. Treatment of hepatitis C in coinfected patients. Future Virol 2015. [DOI: 10.2217/fvl.15.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
HCV and liver disease have emerged as major causes of morbidity and mortality in HIV-positive patients. Treating HCV in patients with HIV has been challenging up until a few years ago due to poorer outcomes with interferon-based therapies in this population. The direct-acting antiviral (DAA) agents offer a new era in the treatment of HCV for all patients regardless of HIV status. This article reviews multiple aspects of the care of the coinfected patient with a focus on the modern DAA agents. HCV clinical treatment trials involving HIV-positive patients and antiretroviral therapy/DAA drug–drug interactions are reviewed in detail.
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Affiliation(s)
- David Del Bello
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, PO Box 1123, Annenberg 21–42, New York, NY 10029, USA
| | - Fanny Ita-Nagy
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, PO Box 1123, Annenberg 21–42, New York, NY 10029, USA
| | - Jonathan Hand
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, PO Box 1123, Annenberg 21–42, New York, NY 10029, USA
| | - Douglas Dieterich
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, PO Box 1123, Annenberg 21–42, New York, NY 10029, USA
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21
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Liver Cirrhosis: Evaluation, Nutritional Status, and Prognosis. Mediators Inflamm 2015; 2015:872152. [PMID: 26494949 PMCID: PMC4606163 DOI: 10.1155/2015/872152] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/08/2015] [Accepted: 07/13/2015] [Indexed: 02/07/2023] Open
Abstract
The liver is the major organ for the metabolism of three major nutrients: protein, fat, and carbohydrate. Chronic hepatitis C virus infection is the major cause of chronic liver disease. Liver cirrhosis (LC) results from different mechanisms of liver injury that lead to necroinflammation and fibrosis. LC has been seen to be not a single disease entity but one that can be graded into distinct clinical stages related to clinical outcome. Several noninvasive methods have been developed for assessing liver fibrosis and these methods have been used for predicting prognosis in patients with LC. On the other hand, subjects with LC often have protein-energy malnutrition (PEM) and poor physical activity. These conditions often result in sarcopenia, which is the loss of skeletal muscle volume and increased muscle weakness. Recent studies have demonstrated that PEM and sarcopenia are predictive factors for poorer survival in patients with LC. Based on these backgrounds, several methods for evaluating nutritional status in patients with chronic liver disease have been developed and they have been preferably used in the clinical field practice. In this review, we will summarize the current knowledge in the field of LC from the viewpoints of diagnostic method, nutritional status, and clinical outcomes.
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Progression of Liver Fibrosis in HIV/HCV Co-Infection: A Comparison between Non-Invasive Assessment Methods and Liver Biopsy. PLoS One 2015; 10:e0138838. [PMID: 26418061 PMCID: PMC4587859 DOI: 10.1371/journal.pone.0138838] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 09/03/2015] [Indexed: 12/15/2022] Open
Abstract
Objectives To evaluate the diagnostic performance of seven non-invasive tests (NITs) of liver fibrosis and to assess fibrosis progression over time in HIV/HCV co-infected patients. Methods Transient elastography (TE) and six blood tests were compared to histopathological fibrosis stage (METAVIR). Participants were followed over three years with NITs at yearly intervals. Results Area under the receiver operating characteristic curve (AUROC) for significant fibrosis (> = F2) in 105 participants was highest for TE (0.85), followed by FIB-4 (0.77), ELF-Test (0.77), APRI (0.76), Fibrotest (0.75), hyaluronic acid (0.70), and Hepascore (0.68). AUROC for cirrhosis (F4) was 0.97 for TE followed by FIB-4 (0.91), APRI (0.89), Fibrotest (0.84), Hepascore (0.82), ELF-Test (0.82), and hyaluronic acid (0.79). A three year follow-up was completed by 87 participants, all on antiretroviral therapy and in 20 patients who completed HCV treatment (9 with sustained virologic response). TE, APRI and Fibrotest did not significantly change during follow-up. There was weak evidence for an increase of FIB-4 (mean increase: 0.22, p = 0.07). 42 participants had a second liver biopsy: Among 38 participants with F0-F3 at baseline, 10 were progessors (1-stage increase in fibrosis, 8 participants; 2-stage, 1; 3-stage, 1). Among progressors, mean increase in TE was 3.35 kPa, in APRI 0.36, and in FIB-4 0.75. Fibrotest results did not change over 3 years. Conclusion TE was the best NIT for liver fibrosis staging in HIV/HCV co-infected patients. APRI-Score, FIB-4 Index, Fibrotest, and ELF-Test were less reliable. Routinely available APRI and FIB-4 performed as good as more expensive tests. NITs did not change significantly during a follow-up of three years, suggesting slow liver disease progression in a majority of HIV/HCV co-infected persons on antiretroviral therapy.
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Diagnostic Value of Conventional and Doppler Ultrasound Findings in Liver Fibrosis in Patients with Chronic Viral Hepatitis. J Med Ultrasound 2015. [DOI: 10.1016/j.jmu.2014.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Gaia S, Campion D, Evangelista A, Spandre M, Cosso L, Brunello F, Ciccone G, Bugianesi E, Rizzetto M. Non-invasive score system for fibrosis in chronic hepatitis: proposal for a model based on biochemical, FibroScan and ultrasound data. Liver Int 2015; 35:2027-35. [PMID: 25495478 DOI: 10.1111/liv.12761] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 12/02/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS We elaborate a non-invasive score system for liver fibrosis (NISF), exploring its diagnostic performance and comparing its accuracy to FibroScan in patients with chronic viral hepatitis (CH) and non-alcoholic fatty liver disease (NAFLD). METHODS Clinical, biochemical, elastographic and ultrasound parameters derived from patients with CH (n = 83) or NAFLD (n = 58), undergoing liver biopsy for fibrosis assessment, were prospectively collected as potential predictors of fibrosis. Each parameter was evaluated for its correlation with the liver biopsy (Gold Standard). Candidate predictors with good interobserver agreement and correlation with histological stages were combined into two algorithms (NISF) to predict fibrosis in chronic viral hepatitis and NAFLD. RESULTS The CH-NISF included six parameters: bluntness of liver edges, irregularity of left lobe surface, diameter of segment 4, liver stiffness measurement, platelet count and ALT values. The ability of the model to discriminate F3-F4 vs F0-F1 stages and F2 vs F0-F1 was high (AUROC of 0.95 and 0.83 respectively) and better than FibroScan alone, especially in intermediate stages (F2 vs F0-F1), AUROC 0.83 vs 0.57 (P = 0.003). The resulting algorithm is available as mathematical formula, nomogram or free online link. [http://health.mafservizi.it/NISF_Calculator/liver.htm] The NAFLD-NISF included liver stiffness, platelet count and AST levels, had good ability to discriminate F0-F1 vs F2-F3-F4 stages (AUROC 0.86), however, not significantly higher than FibroScan. CONCLUSIONS CH-NISF can be proposed as preliminary and easily available staging tool, superior to FibroScan alone in predicting histological fibrosis, especially in intermediate stages. Further validations are needed to improve NISF accuracy in NAFLD.
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Affiliation(s)
- Silvia Gaia
- Department of Gastroenterology, Città della Salute e della Scienza - University Hospital, Turin, Italy
| | - Daniela Campion
- Department of Gastroenterology, Città della Salute e della Scienza - University Hospital, Turin, Italy
| | - Andrea Evangelista
- Department of Epidemiology, Città della Salute e della Scienza - University Hospital, Turin, Italy
| | - Maurizio Spandre
- Department of Gastroenterology, Città della Salute e della Scienza - University Hospital, Turin, Italy
| | - Loretta Cosso
- Department of Gastroenterology, Città della Salute e della Scienza - University Hospital, Turin, Italy
| | - Franco Brunello
- Department of Gastroenterology, Città della Salute e della Scienza - University Hospital, Turin, Italy
| | - Giovannino Ciccone
- Department of Epidemiology, Città della Salute e della Scienza - University Hospital, Turin, Italy
| | - Elisabetta Bugianesi
- Department of Gastroenterology, Città della Salute e della Scienza - University Hospital, Turin, Italy
| | - Mario Rizzetto
- Department of Gastroenterology, Città della Salute e della Scienza - University Hospital, Turin, Italy
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King LY, Canasto-Chibuque C, Johnson KB, Yip S, Chen X, Kojima K, Deshmukh M, Venkatesh A, Tan PS, Sun X, Villanueva A, Sangiovanni A, Nair V, Mahajan M, Kobayashi M, Kumada H, Iavarone M, Colombo M, Fiel MI, Friedman SL, Llovet JM, Chung RT, Hoshida Y. A genomic and clinical prognostic index for hepatitis C-related early-stage cirrhosis that predicts clinical deterioration. Gut 2015; 64:1296-302. [PMID: 25143343 PMCID: PMC4336233 DOI: 10.1136/gutjnl-2014-307862] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 07/29/2014] [Indexed: 12/08/2022]
Abstract
OBJECTIVE The number of patients with HCV-related cirrhosis is increasing, leading to a rising risk of complications and death. Prognostic stratification in patients with early-stage cirrhosis is still challenging. We aimed to develop and validate a clinically useful prognostic index based on genomic and clinical variables to identify patients at high risk of disease progression. DESIGN We developed a prognostic index, comprised of a 186-gene signature validated in our previous genome-wide profiling study, bilirubin (>1 mg/dL) and platelet count (<100,000/mm(3)), in an Italian HCV cirrhosis cohort (training cohort, n=216, median follow-up 10 years). The gene signature test was implemented using a digital transcript counting (nCounter) assay specifically developed for clinical use and the prognostic index was evaluated using archived specimens from an independent cohort of HCV-related cirrhosis in the USA (validation cohort, n=145, median follow-up 8 years). RESULTS In the training cohort, the prognostic index was associated with hepatic decompensation (HR=2.71, p=0.003), overall death (HR=6.00, p<0.001), hepatocellular carcinoma (HR=3.31, p=0.001) and progression of Child-Turcotte-Pugh class (HR=6.70, p<0.001). The patients in the validation cohort were stratified into high-risk (16%), intermediate-risk (42%) or low-risk (42%) groups by the prognostic index. The high-risk group had a significantly increased risk of hepatic decompensation (HR=7.36, p<0.001), overall death (HR=3.57, p=0.002), liver-related death (HR=6.49, p<0.001) and all liver-related adverse events (HR=4.98, p<0.001). CONCLUSIONS A genomic and clinical prognostic index readily available for clinical use was successfully validated, warranting further clinical evaluation for prognostic prediction and clinical trial stratification and enrichment for preventive interventions.
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Affiliation(s)
- Lindsay Y. King
- Liver Center and Gastrointestinal Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, U.S
| | - Claudia Canasto-Chibuque
- Liver Cancer Program, Tisch Cancer Institute, Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, U.S
| | - Kara B. Johnson
- Liver Center and Gastrointestinal Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, U.S
| | - Shun Yip
- Liver Cancer Program, Tisch Cancer Institute, Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, U.S
| | - Xintong Chen
- Liver Cancer Program, Tisch Cancer Institute, Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, U.S
| | - Kensuke Kojima
- Liver Cancer Program, Tisch Cancer Institute, Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, U.S
| | - Manjeet Deshmukh
- Liver Cancer Program, Tisch Cancer Institute, Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, U.S
| | - Anu Venkatesh
- Liver Cancer Program, Tisch Cancer Institute, Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, U.S
| | - Poh Seng Tan
- Liver Cancer Program, Tisch Cancer Institute, Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, U.S,Division of Gastroenterology and Hepatology, University Medicine Cluster, National University Health System, Singapore
| | - Xiaochen Sun
- Liver Cancer Program, Tisch Cancer Institute, Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, U.S
| | | | - Angelo Sangiovanni
- M. & A. Migliavacca Center for Liver Disease and 1st Division of Gastroenterology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Italy
| | - Venugopalan Nair
- Department of Neurology, Icahn School of Medicine at Mount Sinai, U.S
| | - Milind Mahajan
- Institute of Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, U.S
| | | | | | - Massimo Iavarone
- M. & A. Migliavacca Center for Liver Disease and 1st Division of Gastroenterology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Italy
| | - Massimo Colombo
- M. & A. Migliavacca Center for Liver Disease and 1st Division of Gastroenterology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Italy
| | - Maria Isabel Fiel
- Department of Pathology, Icahn School of Medicine at Mount Sinai, U.S
| | - Scott L. Friedman
- Liver Cancer Program, Tisch Cancer Institute, Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, U.S
| | - Josep M. Llovet
- Liver Cancer Program, Tisch Cancer Institute, Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, U.S,HCC Translational Research Laboratory, Barcelona Clinic Liver Cancer Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer Centro de Investigaciones en Red de Enfermedades Hepáticas y Digestivas, Hosptial Clínic Barcelona, Catalonia, Spain,Institució Catalana de Recerca i Estudis Avancats (ICREA), Barcelona, Catalonia, Spain
| | - Raymond T. Chung
- Liver Center and Gastrointestinal Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, U.S
| | - Yujin Hoshida
- Liver Cancer Program, Tisch Cancer Institute, Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, U.S
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Abstract
Hepatitis C virus (HCV) is a leading etiology of hepatocellular carcinoma (HCC). The interaction of HCV with its human host is complex and multilayered; stemming in part from the fact that HCV is a RNA virus with no ability to integrate in the host's genome. Direct and indirect mechanisms of HCV-induced HCC include activation of multiple host pathways such as liver fibrogenic pathways, cellular and survival pathways, interaction with the immune and metabolic systems. Host factors also play a major role in HCV-induced HCC as evidenced by genomic studies identifying polymorphisms in immune, metabolic, and growth signaling systems associated with increased risk of HCC. Despite highly effective direct-acting antiviral agents, the morbidity and incidence of liver-related complications of HCV, including HCC, is likely to persist in the near future. Clinical markers to selectively identify HCV subjects at higher risk of developing HCC have been reported however they require further validation, especially in subjects who have experienced sustained virological response. Molecular biomarkers allowing further refinement of HCC risk are starting to be implemented in clinical platforms, allowing objective stratification of risk and leading to individualized therapy and surveillance for HCV individuals. Another role for molecular biomarker-based stratification could be enrichment of HCC chemoprevention clinical trials leading to smaller sample size, shorter trial duration, and reduced costs.
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Affiliation(s)
- Nicolas Goossens
- Division of Liver Diseases, Department of Medicine, Liver Cancer Program, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
- Division of Gastroenterology and Hepatology, Geneva University Hospital, Geneva, Switzerland
| | - Yujin Hoshida
- Division of Liver Diseases, Department of Medicine, Liver Cancer Program, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
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Tai DI, Tsay PK, Jeng WJ, Weng CC, Huang SF, Huang CH, Lin SM, Chiu CT, Chen WT, Wan YL. Differences in liver fibrosis between patients with chronic hepatitis B and C: evaluation by acoustic radiation force impulse measurements at 2 locations. JOURNAL OF ULTRASOUND IN MEDICINE 2015; 34:813-21. [PMID: 25911714 DOI: 10.7863/ultra.34.5.813] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate liver fibrosis by acoustic radiation force impulse (ARFI) measurements at 2 locations in patients with chronic hepatitis B and C. METHODS A total of 204 consecutive patients (146 male and 58 female) with chronic hepatitis B (n = 121) and C (n = 83) who underwent liver biopsy were enrolled. All patients received ARFI measurements at 2 locations in the right intercostal space on the same day as biopsy. RESULTS There was no difference in median ARFI values between detection locations. However, a significant difference was found for low and high values between locations (median ± SD, 1.38 ± 0.43 versus 1.56 ± 0.55 m/s; P < .001). By receiver operating characteristic (ROC) curve analysis for a METAVIR fibrosis score of F4 (cirrhosis), the lower value of 2 measurements had the highest area under the ROC curve (0.750), followed by the mean value (0.744) and the higher value (0.730). Patients with hepatitis C had a higher area under the ROC curve than patients with hepatitis B (0.824 versus 0.707) for predicting liver cirrhosis. By logistic regression analysis, ARFI was the best modality for predicting liver cirrhosis in hepatitis C, and conventional sonography was the best modality in hepatitis B (P < .001). The ARFI value in patients with hepatitis B was significantly influenced by liver inflammation (P = .019). CONCLUSIONS Acoustic radiation force impulse imaging is the modality of choice for predicting liver cirrhosis in chronic hepatitis C, whereas conventional sonography is still the modality of choice in chronic hepatitis B.
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Affiliation(s)
- Dar-In Tai
- Departments of Gastroenterology and Hepatology (D.-I.T., W.-J.J., C.-C.W., C.-H.H., S.-M.L., C.-T.C., W.-T.C.) and Medical Imaging and Intervention (Y.-L.W.), Chang Gung Memorial Hospital, Taipei, Taiwan; Department of Public Health and Center of Biostatistics, Chang Gung University College of Medicine, Tao-Yuan, Taiwan (P.-K.T.); Division of Molecular and Genomic Medicine, National Health Research Institute, Taipei, Taiwan (S.-F.H.); and Department of Medical Imaging and Radiological Sciences, College of Medicine, Institute for Radiological Research, Chang Gung University, Tao-Yuan, Taiwan (Y.-L.W.)
| | - Pei-Kwei Tsay
- Departments of Gastroenterology and Hepatology (D.-I.T., W.-J.J., C.-C.W., C.-H.H., S.-M.L., C.-T.C., W.-T.C.) and Medical Imaging and Intervention (Y.-L.W.), Chang Gung Memorial Hospital, Taipei, Taiwan; Department of Public Health and Center of Biostatistics, Chang Gung University College of Medicine, Tao-Yuan, Taiwan (P.-K.T.); Division of Molecular and Genomic Medicine, National Health Research Institute, Taipei, Taiwan (S.-F.H.); and Department of Medical Imaging and Radiological Sciences, College of Medicine, Institute for Radiological Research, Chang Gung University, Tao-Yuan, Taiwan (Y.-L.W.)
| | - Wen-Juei Jeng
- Departments of Gastroenterology and Hepatology (D.-I.T., W.-J.J., C.-C.W., C.-H.H., S.-M.L., C.-T.C., W.-T.C.) and Medical Imaging and Intervention (Y.-L.W.), Chang Gung Memorial Hospital, Taipei, Taiwan; Department of Public Health and Center of Biostatistics, Chang Gung University College of Medicine, Tao-Yuan, Taiwan (P.-K.T.); Division of Molecular and Genomic Medicine, National Health Research Institute, Taipei, Taiwan (S.-F.H.); and Department of Medical Imaging and Radiological Sciences, College of Medicine, Institute for Radiological Research, Chang Gung University, Tao-Yuan, Taiwan (Y.-L.W.)
| | - Chia-Chan Weng
- Departments of Gastroenterology and Hepatology (D.-I.T., W.-J.J., C.-C.W., C.-H.H., S.-M.L., C.-T.C., W.-T.C.) and Medical Imaging and Intervention (Y.-L.W.), Chang Gung Memorial Hospital, Taipei, Taiwan; Department of Public Health and Center of Biostatistics, Chang Gung University College of Medicine, Tao-Yuan, Taiwan (P.-K.T.); Division of Molecular and Genomic Medicine, National Health Research Institute, Taipei, Taiwan (S.-F.H.); and Department of Medical Imaging and Radiological Sciences, College of Medicine, Institute for Radiological Research, Chang Gung University, Tao-Yuan, Taiwan (Y.-L.W.)
| | - Shiu-Feng Huang
- Departments of Gastroenterology and Hepatology (D.-I.T., W.-J.J., C.-C.W., C.-H.H., S.-M.L., C.-T.C., W.-T.C.) and Medical Imaging and Intervention (Y.-L.W.), Chang Gung Memorial Hospital, Taipei, Taiwan; Department of Public Health and Center of Biostatistics, Chang Gung University College of Medicine, Tao-Yuan, Taiwan (P.-K.T.); Division of Molecular and Genomic Medicine, National Health Research Institute, Taipei, Taiwan (S.-F.H.); and Department of Medical Imaging and Radiological Sciences, College of Medicine, Institute for Radiological Research, Chang Gung University, Tao-Yuan, Taiwan (Y.-L.W.)
| | - Chien-Hao Huang
- Departments of Gastroenterology and Hepatology (D.-I.T., W.-J.J., C.-C.W., C.-H.H., S.-M.L., C.-T.C., W.-T.C.) and Medical Imaging and Intervention (Y.-L.W.), Chang Gung Memorial Hospital, Taipei, Taiwan; Department of Public Health and Center of Biostatistics, Chang Gung University College of Medicine, Tao-Yuan, Taiwan (P.-K.T.); Division of Molecular and Genomic Medicine, National Health Research Institute, Taipei, Taiwan (S.-F.H.); and Department of Medical Imaging and Radiological Sciences, College of Medicine, Institute for Radiological Research, Chang Gung University, Tao-Yuan, Taiwan (Y.-L.W.)
| | - Shi-Ming Lin
- Departments of Gastroenterology and Hepatology (D.-I.T., W.-J.J., C.-C.W., C.-H.H., S.-M.L., C.-T.C., W.-T.C.) and Medical Imaging and Intervention (Y.-L.W.), Chang Gung Memorial Hospital, Taipei, Taiwan; Department of Public Health and Center of Biostatistics, Chang Gung University College of Medicine, Tao-Yuan, Taiwan (P.-K.T.); Division of Molecular and Genomic Medicine, National Health Research Institute, Taipei, Taiwan (S.-F.H.); and Department of Medical Imaging and Radiological Sciences, College of Medicine, Institute for Radiological Research, Chang Gung University, Tao-Yuan, Taiwan (Y.-L.W.)
| | - Cheng-Tang Chiu
- Departments of Gastroenterology and Hepatology (D.-I.T., W.-J.J., C.-C.W., C.-H.H., S.-M.L., C.-T.C., W.-T.C.) and Medical Imaging and Intervention (Y.-L.W.), Chang Gung Memorial Hospital, Taipei, Taiwan; Department of Public Health and Center of Biostatistics, Chang Gung University College of Medicine, Tao-Yuan, Taiwan (P.-K.T.); Division of Molecular and Genomic Medicine, National Health Research Institute, Taipei, Taiwan (S.-F.H.); and Department of Medical Imaging and Radiological Sciences, College of Medicine, Institute for Radiological Research, Chang Gung University, Tao-Yuan, Taiwan (Y.-L.W.)
| | - Wei-Ting Chen
- Departments of Gastroenterology and Hepatology (D.-I.T., W.-J.J., C.-C.W., C.-H.H., S.-M.L., C.-T.C., W.-T.C.) and Medical Imaging and Intervention (Y.-L.W.), Chang Gung Memorial Hospital, Taipei, Taiwan; Department of Public Health and Center of Biostatistics, Chang Gung University College of Medicine, Tao-Yuan, Taiwan (P.-K.T.); Division of Molecular and Genomic Medicine, National Health Research Institute, Taipei, Taiwan (S.-F.H.); and Department of Medical Imaging and Radiological Sciences, College of Medicine, Institute for Radiological Research, Chang Gung University, Tao-Yuan, Taiwan (Y.-L.W.)
| | - Yung-Liang Wan
- Departments of Gastroenterology and Hepatology (D.-I.T., W.-J.J., C.-C.W., C.-H.H., S.-M.L., C.-T.C., W.-T.C.) and Medical Imaging and Intervention (Y.-L.W.), Chang Gung Memorial Hospital, Taipei, Taiwan; Department of Public Health and Center of Biostatistics, Chang Gung University College of Medicine, Tao-Yuan, Taiwan (P.-K.T.); Division of Molecular and Genomic Medicine, National Health Research Institute, Taipei, Taiwan (S.-F.H.); and Department of Medical Imaging and Radiological Sciences, College of Medicine, Institute for Radiological Research, Chang Gung University, Tao-Yuan, Taiwan (Y.-L.W.)
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Donepudi I, Paredes A, Hubbard S, Awad C, Sterling RK. Utility of evaluating HCV in an uninsured population. Dig Dis Sci 2015; 60:1092-7. [PMID: 25371153 DOI: 10.1007/s10620-014-3416-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 10/27/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Although effective HCV treatment is available, it can be difficult to access for uninsured, urban patients. Our aim was to assess the utility of evaluation and outcomes in the uninsured with HCV when access to health care and treatment with triple therapy is provided. METHODS We performed a retrospective review of consecutive patients referred for HCV from 2011 to June 2013 to an indigent HCV clinic. The primary outcomes were assessment of disease severity by noninvasive means and initiation of therapy. RESULTS We identified 350 patients: mean age 50.6, 84 % with no insurance, 62 % men, 58 % black, 91 % HCV treatment naïve. Of these, 148 underwent liver biopsy and 68 % had F0-F1 and 10 % had F3-F4 fibrosis. FIB-4 and APRI were highly correlated (r = 0.9; p < .0001) and correctly classified patients by fibrosis strata (F0-F1, F2, and F3-F4; p = .0004). When combined, a FIB-4 ≤1.5 and APRI ≤0.5 correctly classified the absence of advanced disease in 97 % (p < .0001). Of those evaluated, 39 (11 %) went on to HCV treatment. Of those not in a clinical trial, 51 % completed treatment with SVR in 61 % with genotype 1 and 75 % in genotypenon-1. Of those not treated (n = 309), the most common reasons were mild disease (16 %), lost to follow-up (23 %), ongoing alcohol or substance abuse (24 %), and uncontrolled depression (10 %). CONCLUSION Noninvasive assessment can accurately exclude advanced fibrosis. Despite access to care, the utility of evaluating to initiate HCV treatment is low suggesting that eliminating the barrier to health care may not increase HCV treatment.
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Affiliation(s)
- Indira Donepudi
- Section of Hepatology, Virginia Commonwealth University, 1200 E Broad St, West Hospital, Rm 1478, PO Box 980341, Richmond, VA, 23298-0341, USA
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Fernandes FF, Ferraz ML, Andrade LE, Dellavance A, Terra C, Pereira G, Pereira JL, Campos F, Figueiredo F, Perez RM. Enhanced liver fibrosis panel as a predictor of liver fibrosis in chronic hepatitis C patients. J Clin Gastroenterol 2015; 49:235-41. [PMID: 24714186 DOI: 10.1097/mcg.0000000000000128] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Evaluation of fibrosis is crucial in the assessment of chronic hepatitis C (CHC). The enhanced liver fibrosis (ELF) is a serological panel including hyaluronic acid (HA), tissue inhibitor of matrix metalloproteinases-1 (TIMP-1), and amino-terminal propeptide of type III procollagen (PIIINP) that has shown good results in predicting liver fibrosis in distinct scenarios of chronic liver diseases. AIMS We aimed to assess the performance of ELF on the detection of fibrosis and cirrhosis in a CHC patient cohort and to compare the results of ELF and transient elastography (TE-Fibroscan) using liver biopsy as reference. PATIENTS AND METHODS One hundred twenty patients were prospectively evaluated by TE and ELF using an ADVIA Centaur automated system. The ELF score was calculated using the manufacturer's algorithm. Biopsies were classified according to the METAVIR score. Receiver operator characteristic curve analyses were performed to evaluate the accuracy of ELF and TE. RESULTS The area under the receiver operator characteristic curve (AUROC) of ELF for the diagnosis of significant fibrosis was 0.81 [95% confidence interval (CI), 0.73-0.87], for advanced fibrosis was 0.82 (95% CI, 0.74-0.88), and for cirrhosis was 0.78 (95% CI, 0.70-0.85). Using the proposed cutoffs, ELF overestimated fibrosis in 66% (81/120) of cases and underestimated in 3% (3/120). We found no statistically significant difference when comparing the AUROC of ELF and TE for diagnosing fibrosis or cirrhosis. CONCLUSIONS ELF panel is a good noninvasive fibrosis marker and showed similar results to TE in CHC patients. However, new cutoff points need to be established to improve its performance on patients with CHC.
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Affiliation(s)
- Flavia F Fernandes
- *Gastroenterology Department, University of the State of Rio de Janeiro †Department of Gastroenterology, Bonsucesso Federal Hospital §D'Or Institute for Research and Education #Internal Medicine Department, Federal University of Rio de Janeiro, Rio de Janeiro ‡Gastroenterology Department, Federal University of São Paulo ∥Rheumatology Division, Universidade Federal de São Paulo, UNIFESP, São Paulo ¶Department of Research and Development, Fleury Group, Brazil
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Abstract
There are an estimated 40 million HIV infected individuals worldwide, with chronic liver disease being the 2nd leading cause of mortality in this population. Elevated liver functions are commonly noted in HIV patients and the etiologies are varied. Viral hepatitis B and C, fatty liver and drug induced liver injury are more common. Treatment options for viral hepatitis C are rapidly evolving and are promising, but treatments are limited for the other conditions and is primarily supportive. Opportunistic infections of the liver are now uncommon. Irrespective of etiology, management requires referral to specialized centers and with due diligence mortality can be reduced.
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Siddiqui MS, Patidar KR, Boyett S, Smith PG, Sanyal AJ, Sterling RK. Validation of noninvasive methods for detecting hepatic steatosis in patients with human immunodeficiency virus infection. Clin Gastroenterol Hepatol 2015; 13:402-5. [PMID: 25004459 PMCID: PMC4900156 DOI: 10.1016/j.cgh.2014.06.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 06/28/2014] [Accepted: 06/30/2014] [Indexed: 02/07/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is common among patients with human immunodeficiency virus (HIV) infection; a reliable noninvasive method of detection is needed. We aimed to validate noninvasive means of identifying steatosis in HIV-positive patients. We performed a single-center retrospective study to validate the abilities of the liver fat score (LFS) and the lipid accumulation product (LAP) to detect hepatic steatosis in HIV-positive patients, compared with HIV-negative individuals (controls); NAFLD was confirmed by histology, and findings were compared with those from ultrasonography. These models then were validated in HIV-positive patients with NAFLD vs patients co-infected with HIV and hepatitis C virus (HCV) infection, without hepatic steatosis. LFS identified hepatic steatosis in HIV-positive subjects, compared with controls, with an area under the receiver operating curve value of 0.971 ± 0.027 (95% confidence interval, 0.91-1.000). At a cut-off value of -0.945, the LFS identified patients with steatosis with 100% sensitivity and 84% specificity. At a cut-off of value of -0.234, the LFS differentiated between HIV-positive subjects with NAFLD and patients co-infected with HIV and HCV with 100% sensitivity and 74% specificity. LAP scores ≥38 identified HIV-positive patients with steatosis with 89% sensitivity and 83% specificity. LAP scores ≥42 differentiated between HIV-positive subjects with steatosis and patients co-infected with HIV and HCV with 89% specificity and 70% sensitivity. We validated the accuracy of LFS and LAP in detecting hepatic steatosis in HIV-positive patients.
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Nishikawa H, Osaki Y, Komekado H, Sakamoto A, Saito S, Nishijima N, Nasu A, Arimoto A, Kita R, Kimura T. Clinical implication of the preoperative GSA index in ⁹⁹mTc-GSA scintigraphy in hepatitis C virus-related hepatocellular carcinoma. Oncol Rep 2014; 33:1071-8. [PMID: 25528990 DOI: 10.3892/or.2014.3691] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 11/25/2014] [Indexed: 11/05/2022] Open
Abstract
We aimed to examine the relationship between the preoperative GSA index [uptake ratio of the liver to the liver plus heart at 15 min (LHL15) to uptake ratio of the heart at 15 min to that at 3 min (HH15) ratio] calculated from 99mTc‑labeled diethylene triamine pentaacetate-galactosyl human serum albumin (99mTc-GSA) scintigraphy and background liver fibrosis and to investigate whether the GSA index can be a useful predictor in hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) patients treated with surgical resection (SR). A total of 213 HCV-related HCC patients were analyzed. Receiver operating characteristic (ROC) curve analysis was performed for calculating the area under the ROC (AUROC) for nine noninvasive parameters including GSA index, indocyanine green retention at 15 min, aspartate aminotransferase (AST) to platelet ratio index, FIB-4 index, AST to alanine aminotransferase ratio, serum albumin, total bilirubin, platelet count and prothrombin time for cirrhosis. We also examined predictive factors associated with overall survival (OS) and recurrence-free survival (RFS) after SR in univariate and multivariate analyses. There were 153 males and 60 females with the mean age of 69.9 years. The median observation periods were 2.8 years. The mean maximum tumor size was 4.1 cm. HH15 ranged from 0.452 to 0.897. LHL15 ranged from 0.669 to 0.982. The mean value of the GSA index was 1.41. Among the nine parameters, the GSA index yielded the highest AUROC for cirrhosis with a level of 0.786 at an optimal cut-off value of 1.37 (sensitivity, 65.9%; specificity, 79.0%). In multivariate analyses, the GSA index was an independent predictor (P<0.001) linked to RFS and it had a marginal significance in terms of OS (P=0.074). In conclusion, the preoperative GSA index can be a useful predictor in HCV-related HCC patients treated with SR.
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Affiliation(s)
- Hiroki Nishikawa
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Tennoji-ku, Osaka 543-0027, Japan
| | - Yukio Osaki
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Tennoji-ku, Osaka 543-0027, Japan
| | - Hideyuki Komekado
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Tennoji-ku, Osaka 543-0027, Japan
| | - Azusa Sakamoto
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Tennoji-ku, Osaka 543-0027, Japan
| | - Sumio Saito
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Tennoji-ku, Osaka 543-0027, Japan
| | - Norihiro Nishijima
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Tennoji-ku, Osaka 543-0027, Japan
| | - Akihiro Nasu
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Tennoji-ku, Osaka 543-0027, Japan
| | - Akira Arimoto
- Department of Surgery, Osaka Red Cross Hospital, Tennoji-ku, Osaka 543-0027, Japan
| | - Ryuichi Kita
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Tennoji-ku, Osaka 543-0027, Japan
| | - Toru Kimura
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Tennoji-ku, Osaka 543-0027, Japan
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Hoshida Y, Fuchs BC, Bardeesy N, Baumert TF, Chung RT. Pathogenesis and prevention of hepatitis C virus-induced hepatocellular carcinoma. J Hepatol 2014; 61:S79-90. [PMID: 25443348 PMCID: PMC4435677 DOI: 10.1016/j.jhep.2014.07.010] [Citation(s) in RCA: 150] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 07/03/2014] [Accepted: 07/10/2014] [Indexed: 02/08/2023]
Abstract
Hepatitis C virus (HCV) is one of the major aetiologic agents that causes hepatocellular carcinoma (HCC) by generating an inflammatory, fibrogenic, and carcinogenic tissue microenvironment in the liver. HCV-induced HCC is a rational target for cancer preventive intervention because of the clear-cut high-risk condition, cirrhosis, associated with high cancer incidence (1% to 7% per year). Studies have elucidated direct and indirect carcinogenic effects of HCV, which have in turn led to the identification of candidate HCC chemoprevention targets. Selective molecular targeted agents may enable personalized strategies for HCC chemoprevention. In addition, multiple experimental and epidemiological studies suggest the potential value of generic drugs or dietary supplements targeting inflammation, oxidant stress, or metabolic derangements as possible HCC chemopreventive agents. While the successful use of highly effective direct-acting antiviral agents will make important inroads into reducing long-term HCC risk, there will remain an important role for HCC chemoprevention even after viral cure, given the persistence of HCC risk in persons with advanced HCV fibrosis, as shown in recent studies. The successful development of cancer preventive therapies will be more challenging compared to cancer therapeutics because of the requirement for larger and longer clinical trials and the need for a safer toxicity profile given its use as a preventive agent. Molecular biomarkers to selectively identify high-risk population could help mitigate these challenges. Genome-wide, unbiased molecular characterization, high-throughput drug/gene screening, experimental model-based functional analysis, and systems-level in silico modelling are expected to complement each other to facilitate discovery of new HCC chemoprevention targets and therapies.
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Affiliation(s)
- Yujin Hoshida
- Liver Cancer Program, Tisch Cancer Institute, Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, United States.
| | - Bryan C Fuchs
- Division of Surgical Oncology, Massachusetts General Hospital, Harvard Medical School, United States
| | - Nabeel Bardeesy
- Cancer Center, Massachusetts General Hospital, Harvard Medical School, United States
| | - Thomas F Baumert
- INSERM Unité 1110, Institut de Recherche sur les Maladies Virales et Hépatiques, Université de Strasbourg, and Institut Hospitalo-Universitaire, Pôle Hépato-digestif, Hôpitaux Universitaires de Strasbourg, France; Liver Center and Gastrointestinal Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, United States
| | - Raymond T Chung
- Liver Center and Gastrointestinal Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, United States.
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NISHIKAWA HIROKI, OSAKI YUKIO, KOMEKADO HIDEYUKI, SAKAMOTO AZUSA, SAITO SUMIO, NISHIJIMA NORIHIRO, NASU AKIHIRO, ARIMOTO AKIRA, KITA RYUICHI, KIMURA TORU. Clinical significance of the FIB-4 index for non-B non-C hepatocellular carcinoma treated with surgical resection. Oncol Rep 2014; 33:88-94. [DOI: 10.3892/or.2014.3573] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 10/07/2014] [Indexed: 11/05/2022] Open
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Kobayashi K, Nakao H, Nishiyama T, Lin Y, Kikuchi S, Kobayashi Y, Yamamoto T, Ishii N, Ohashi T, Satoh K, Nakade Y, Ito K, Yoneda M. Diagnostic accuracy of real-time tissue elastography for the staging of liver fibrosis: a meta-analysis. Eur Radiol 2014; 25:230-8. [PMID: 25149296 DOI: 10.1007/s00330-014-3364-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 07/07/2014] [Accepted: 07/18/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the overall accuracy of real-time tissue elastography (RTE) for the staging of liver fibrosis. METHODS We systematically reviewed 15 studies (1,626 subjects) in which sensitivity and specificity of RTE for liver fibrosis are available. For each cut-off stage of fibrosis, i.e., F ≥ 1, F ≥ 2, F ≥ 3, and F ≥ 4, summary sensitivity and specificity were estimated using a bivariate random-effects model. Publication bias was assessed using funnel plots and Egger's test. RESULTS Summary sensitivity and specificity were 0.79 and 0.76 for F ≥ 2, 0.82 and 0.81 for F ≥ 3, and 0.74 and 0.84 for F ≥ 4, respectively. Meta-regressions revealed scoring methods of RTE and liver diseases in the samples might not influence sensitivity and specificity of RTE. However, the estimated accuracy of RTE might be overestimated due to publication bias (p = 0.004 for F ≥ 2, p < 0.001 for F ≥ 3, and p = 0.002 for F ≥ 4). CONCLUSIONS RTE is not highly accurate for any cut-off stage of fibrosis. Compared with findings of meta-analyses on Transient Elastography and Acoustic Radiation Force Impulse imaging, the overall accuracy of RTE seems to be nearly identical for the evaluation of significant liver fibrosis, but less accurate for the evaluation of cirrhosis. KEY POINTS • Non-invasive methods for evaluating liver fibrosis are necessary to replace liver biopsy. • ARFI is as accurate as TE for evaluating liver fibrosis. • RTE may be as accurate as TE and ARFI for fibrosis. • RTE may be less accurate than TE and ARFI for cirrhosis. • The estimated accuracy of RTE may be overestimated by publication bias.
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Affiliation(s)
- Kunio Kobayashi
- Division of Gastroenterology, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
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Van Gossum A, Pironi L, Messing B, Moreno C, Colecchia A, D’Errico A, Demetter P, De Gos F, Cazals-Halem D, Joly F. Transient Elastography (FibroScan) Is Not Correlated With Liver Fibrosis but With Cholestasis in Patients With Long-Term Home Parenteral Nutrition. JPEN J Parenter Enteral Nutr 2014; 39:719-24. [DOI: 10.1177/0148607114538057] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 04/29/2014] [Indexed: 12/19/2022]
Affiliation(s)
- André Van Gossum
- Department of Gastroenterology and Pathology, Hôpital Erasme, Brussels, Belgium
| | - Loris Pironi
- Department of Gastroenterology and Pathology, St Orsola-Malpighi Hospital, Bologna, Italy
| | - Bernard Messing
- Department of Gastroenterology and Pathology, Hôpital Beaujon, Paris, France
| | - Christophe Moreno
- Department of Gastroenterology and Pathology, Hôpital Erasme, Brussels, Belgium
| | - Antonio Colecchia
- Department of Gastroenterology and Pathology, St Orsola-Malpighi Hospital, Bologna, Italy
| | - Antonietta D’Errico
- Department of Gastroenterology and Pathology, St Orsola-Malpighi Hospital, Bologna, Italy
| | - Pieter Demetter
- Department of Gastroenterology and Pathology, Hôpital Erasme, Brussels, Belgium
| | - Françoise De Gos
- Department of Gastroenterology and Pathology, Hôpital Beaujon, Paris, France
| | | | - Francisca Joly
- Department of Gastroenterology and Pathology, Hôpital Beaujon, Paris, France
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Aktug Demir N, Kolgelier S, Ozcimen S, Gungor G, Sumer S, Saltuk Demir L, Inkaya AC, Ural O. Evaluation of the relation between hepatic fibrosis and basic laboratory parameters in patients with chronic hepatitis B fibrosis and basic laboratory parameters. HEPATITIS MONTHLY 2014; 14:e16975. [PMID: 24748897 PMCID: PMC3989596 DOI: 10.5812/hepatmon.16975] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 02/24/2014] [Accepted: 03/06/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND The hepatitis B virus is an important healthcare problem. According to current clinical practice, a liver biopsy is required for the diagnosis and treatment of chronic liver disease. However, a liver biopsy is an invasive, inconvenient procedure, which requires an expert pathologist opinion. Therefore requirement of biochemical tests, which are considered to indicate hepatic fibrosis and may be repeated easily, increases gradually today. OBJECTIVES This study evaluated the correlation between hepatic fibrosis and routine laboratory values in patients with chronic hepatitis B. PATIENTS AND METHODS The files of 456 patients with CHB (chronic hepatitis B) who were referred to the infectious diseases and clinical microbiology clinic between January 2009 and March 2012 were screened retrospectively. Liver biopsy samples were examined according to Ishak scoring. Laboratory parameters and histopathology reports were recorded, and correlations between the fibrosis grade and laboratory parameters were analyzed. RESULTS There were 320 male and 136 female patients, with a mean age 36.7 ± 12.1 years. According to liver biopsy results, a low fibrosis score (stage 0-2) was detected in 281 patients (61.6%), and a high fibrosis score (stage 3-5) was detected in 175 patients (38.4%). Patients with a high fibrosis score had significantly higher ALT (alanine amino transferase), AST (aspartate aminotransferase), and HBV-DNA values and a significantly lower platelet count compared with those with a low fibrosis score (P = 0.001, 0.001, 0.025, and 0.001, respectively). A positive correlation was detected between the fibrosis score and age, BMI, HAI, ALT, and AST values, and a negative correlation was detected between the fibrosis score and albumin and platelet counts. In the regression analysis performed to evaluate the factors associated with high-stage fibrosis, fibrosis was determined to be associated with thrombosis, ALT, and gender. The results of the regression analysis demonstrated that the risk of fibrosis was 4.6 fold higher in men. CONCLUSIONS According to the results obtained in our study, advanced age, higher BMI, AST, ALT, and HBV-DNA levels, and low albumin and platelet levels are correlated with advanced fibrosis in patients with CHB.
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Affiliation(s)
- Nazlim Aktug Demir
- Infectious Diseases and Clinical Microbiology Department, Selcuk University, Konya, Turkey
| | - Servet Kolgelier
- Infectious Diseases and Clinical Microbiology Department, Adiyaman University, Adiyaman, Turkey
| | - Serap Ozcimen
- Infectious Diseases and Clinical Microbiology Department, Konya State Hospital, Konya, Turkey
| | - Gokhan Gungor
- Gastroenterology Department, Konya Education and Training Hospital, Konya, Turkey
| | - Sua Sumer
- Infectious Diseases and Clinical Microbiology Department, Selcuk University, Konya, Turkey
- Corresponding Author: Sua Sumer, Infectious Diseases and Clinical Microbiology Department, Selcuk University, Konya, Turkey. Tel: +90-5058746251, Fax: +90-3322412184, E-mail:
| | | | - Ahmet Cagkan Inkaya
- Infectious Diseases and Clinical Microbiology Department, Hacettepe University, Ankara, Turkey
| | - Onur Ural
- Infectious Diseases and Clinical Microbiology Department, Selcuk University, Konya, Turkey
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Kayadibi H, Yasar B, Ozkara S, Serdar MA, Kurdas OO, Gonen C. The diagnostic accuracy of the Forns index, platelet count and AST to Platelet Ratio Index derived fibrosis index for the prediction of Hepatitis C virus-related significant liver fibrosis and cirrhosis. Scand J Clin Lab Invest 2014; 74:240-7. [PMID: 24460024 DOI: 10.3109/00365513.2013.879392] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIM To provide a simple fibrosis index combining the routine laboratory markers for predicting significant fibrosis (SF) and cirrhosis in patients with chronic HCV. METHODS Platelet count, ALT, AST, AST to ALT Ratio, AST to Platelet Ratio Index (APRI), Forns index, FIB-4 and Age Platelet Index of 202 liver biopsy performed HCV-infected patients were reviewed. METAVIR classification was used to determine the stage of liver fibrosis. The predictive fibrosis index was constructed by multiple linear regression analysis (- 2.948 + 0.562 × Forns index + 0.288 × APRI + 0.006 × platelet count [10(9)/L]). RESULTS Median (25th-75th interquartile range) age was 52 (42-59) years, and 61% were male. 65.8% (n = 133) had SF (F2-F4) and 23.3% (n = 47) had cirrhosis (F4). For discrimination of SF, AUROCs were: Fibrosis index = 0.869, Forns index = 0.837, APRI = 0.814, platelet count = 0.764. For cirrhosis, AUROCs were: Fibrosis index = 0.911, Forns index = 0.883, APRI = 0.847, platelet count = 0.827. A cut-off point of ≤ 1.2 for fibrosis index excluded SF in 89% of patients with sensitivity of 96%, while > 2.0 predicted SF in 88% of patients with specificity of 86%. Threshold of ≤ 1.9 excluded cirrhosis in 95% of patients with sensitivity of 94%, while > 2.7 showed cirrhosis in 88% of patients with specificity of 95%. In multivariate logistic regression analysis, OR (95% CI) of fibrosis index was 7.825 (3.682-16.629) for SF (p < 0.001) and was 8.672 (4.179-17.996) for cirrhosis (p < 0.001). CONCLUSION SF and cirrhosis were predicted with accuracy of 82% and 89% and were excluded with accuracy of 74% and 82% using this fibrosis index which may potentially decrease the need for liver biopsy in 76% and 83% of patients, respectively.
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Affiliation(s)
- Huseyin Kayadibi
- Department of Medical Biochemistry, Adana Military Hospital , Adana , Turkey
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Schiavon LDL, Narciso-Schiavon JL, Carvalho-Filho RJD. Non-invasive diagnosis of liver fibrosis in chronic hepatitis C. World J Gastroenterol 2014; 20:2854-2866. [PMID: 24659877 PMCID: PMC3961992 DOI: 10.3748/wjg.v20.i11.2854] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 12/20/2013] [Accepted: 01/15/2014] [Indexed: 02/06/2023] Open
Abstract
Assessment of liver fibrosis in chronic hepatitis C virus (HCV) infection is considered a relevant part of patient care and key for decision making. Although liver biopsy has been considered the gold standard for staging liver fibrosis, it is an invasive technique and subject to sampling errors and significant intra- and inter-observer variability. Over the last decade, several noninvasive markers were proposed for liver fibrosis diagnosis in chronic HCV infection, with variable performance. Besides the clear advantage of being noninvasive, a more objective interpretation of test results may overcome the mentioned intra- and inter-observer variability of liver biopsy. In addition, these tests can theoretically offer a more accurate view of fibrogenic events occurring in the entire liver with the advantage of providing frequent fibrosis evaluation without additional risk. However, in general, these tests show low accuracy in discriminating between intermediate stages of fibrosis and may be influenced by several hepatic and extra-hepatic conditions. These methods are either serum markers (usually combined in a mathematical model) or imaging modalities that can be used separately or combined in algorithms to improve accuracy. In this review we will discuss the different noninvasive methods that are currently available for the evaluation of liver fibrosis in chronic hepatitis C, their advantages, limitations and application in clinical practice.
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Kang W, Kim SU, Ahn SH. Non-invasive prediction of forthcoming cirrhosis-related complications. World J Gastroenterol 2014; 20:2613-2623. [PMID: 24627597 PMCID: PMC3949270 DOI: 10.3748/wjg.v20.i10.2613] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 01/02/2014] [Accepted: 02/20/2014] [Indexed: 02/06/2023] Open
Abstract
In patients with chronic liver diseases, identification of significant liver fibrosis and cirrhosis is essential for determining treatment strategies, assessing therapeutic response, and stratifying long-term prognosis. Although liver biopsy remains the reference standard for evaluating the extent of liver fibrosis in patients with chronic liver diseases, several non-invasive methods have been developed as alternatives to liver biopsies. Some of these non-invasive methods have demonstrated clinical accuracy for diagnosing significant fibrosis or cirrhosis in many cross-sectional studies with the histological fibrosis stage as a reference standard. However, non-invasive methods cannot be fully validated through cross-sectional studies since liver biopsy is not a perfect surrogate endpoint marker. Accordingly, recent studies have focused on assessing the performance of non-invasive methods through long-term, longitudinal, follow-up studies with solid clinical endpoints related to advanced stages of liver fibrosis and cirrhosis. As a result, current view is that these alternative methods can independently predict future cirrhosis-related complications, such as hepatic decompensation, liver failure, hepatocellular carcinoma, or liver-related death. The clinical role of non-invasive models seems to be shifting from a simple tool for predicting the extent of fibrosis to a surveillance tool for predicting future liver-related events. In this article, we will summarize recent longitudinal studies of non-invasive methods for predicting forthcoming complications related to liver cirrhosis and discuss the clinical value of currently available non-invasive methods based on evidence from the literature.
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Fibrosis in hepatitis C patients predicts complications after elective total joint arthroplasty. J Arthroplasty 2014; 29:7-10. [PMID: 23648106 DOI: 10.1016/j.arth.2013.03.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 03/21/2013] [Accepted: 03/21/2013] [Indexed: 02/01/2023] Open
Abstract
Effects of Hepatitis C on total hip (THA) and total knee arthroplasty (TKA) outcomes are poorly understood. Seventy-two hepatitis C patients underwent 77 primary THA or TKA and were retrospectively identified, stratified by fibrosis and thrombocytopenia and compared to matched controls. Overall, Hepatitis C and control patients had similar outcomes. After TKA, fibrotic hepatitis C patients demonstrated a greater average hemoglobin drop than non-fibrotic hepatitis C patients (4.9 versus 3.8, P=0.023), greater deep infection rate (21% versus 0%, P=0.047), and rate of cellulitis (21% versus 0%, P=0.047). Thrombocytopenia showed a trend toward greater infections. Prior to fibrosis, Hepatitis C patients appear to be at no increased risk of complication after joint arthroplasty. Evaluation of fibrosis may predict poor outcome in Hepatitis C patients.
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Gabr SA, Alghadir AH. Prediction of fibrosis in hepatitis C patients: assessment using hydroxyproline and oxidative stress biomarkers. Virusdisease 2013; 25:91-100. [PMID: 24426315 DOI: 10.1007/s13337-013-0182-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 11/11/2013] [Indexed: 12/27/2022] Open
Abstract
This study aims to evaluate the diagnostic accuracy of aspartate aminotransferase (AST), alanine aminotransferase (ALT), hydroxyproline (Hyp), malondialdhyde (MDA), superoxide dismutase (SOD), and total antioxidant status (TAS) biomarkers in comparison with Metavir scoring for assessing the severity of hepatic fibrosis in the HCV patients. The histological activity index (HAI) was evaluated in liver biopsy by Metavir scoring system in 150 patients with HCV. HCV initial screening, further genotyping and biochemical data analysis were performed in serum using ELISA and biochemical assays. Out of the 150 HCV patients in this study, the most prevalent HCV genotype was genotype 4 (97 %). The significant fibrosis was estimated in 83.3 % of patients using the Metavir scoring system. They classified into 40 % of patients with mild fibrosis (F0-F1); 60 % with significant fibrosis (F2-4) and 20 % had cirrhosis (F4). Patients with cirrhosis (F4) showed significant correlation (P < 0.001) with increase in ALT, AST, AST/ALT, Hyp, Hyp/platelet count ratio, APRI, MDA, older age, and decrease (P < 0.001) in SOD, TAS, and platelet count compared to other stages of liver fibrosis. In our population, using optimized cut-off values of AST/ALT, APRI, Hyp, MDA, SOD, and TAS, significant fibrosis could be predicted accurately with a range of (80-90 %), and cirrhosis with a range of (67-97 %) of HCV patients. Our study showed that, oxidative stress and Hyp markers could be useful as noninvasive diagnostic markers in the assessment of hepatic fibrosis.
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Affiliation(s)
- Sami A Gabr
- Department of Anatomy, Faculty of Medicine, Mansoura University, Mansoura, Egypt ; Department of Rehabilitation Science, College of Applied Medical Sciences, King Saud University, Riyadh, KSA
| | - Ahmad H Alghadir
- Department of Rehabilitation Science, College of Applied Medical Sciences, King Saud University, Riyadh, KSA
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Martel-Laferrière V, Wong M, Dieterich DT. HIV/hepatitis C virus-coinfected patients and cirrhosis: how to diagnose it and what to do next? Clin Infect Dis 2013; 58:840-7. [PMID: 24178247 DOI: 10.1093/cid/cit714] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Liver disease, specifically cirrhosis, is a leading cause of morbidity and mortality in human immunodeficiency virus (HIV)-infected patients. The diagnosis of early cirrhosis in HIV/hepatitis C virus (HCV)-coinfected patients may be challenging. The development of noninvasive methods for fibrosis assessment empowers the infectious disease specialist to diagnose advanced fibrosis or cirrhosis. Early diagnosis is essential to enroll patients in screening programs for esophageal varices and hepatocellular carcinoma. Cirrhosis may also modify decisions about treatment of both HIV and HCV, including vaccination, medications chosen, and referral for liver transplant.
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Affiliation(s)
- Valérie Martel-Laferrière
- Département de Microbiologie et Infectiologie, Centre Hospitalier de l'Université de Montréal, Quebec, Canada
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Abstract
Hepatitis C virus (HCV) infection is the most common etiology of chronic liver disease in Western countries. Morbidity and mortality due to HCV-related end-stage liver disease are increasing, just as novel therapeutics arrive with the promise of better cure rates that prevent these complications. However, substantial barriers to successful application of these novel treatments remain, including the lack of providers with sufficient knowledge to address this epidemic. To address these deficits, this article aims to provide a general framework with algorithms to guide initial management decisions for HCV genotype 1 infection, the most commonly found genotype, based on therapies approved as of 2013.
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45
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Nierhoff J, Chávez Ortiz AA, Herrmann E, Zeuzem S, Friedrich-Rust M. The efficiency of acoustic radiation force impulse imaging for the staging of liver fibrosis: a meta-analysis. Eur Radiol 2013; 23:3040-53. [DOI: 10.1007/s00330-013-2927-6] [Citation(s) in RCA: 137] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 05/07/2013] [Accepted: 05/12/2013] [Indexed: 12/14/2022]
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Virtual laparoscopy: Initial experience with three-dimensional ultrasonography to characterize hepatic surface features. Eur J Radiol 2013; 82:929-34. [DOI: 10.1016/j.ejrad.2013.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 12/12/2012] [Accepted: 01/11/2013] [Indexed: 01/06/2023]
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Hoshida Y, Villanueva A, Sangiovanni A, Sole M, Hur C, Andersson KL, Chung RT, Gould J, Kojima K, Gupta S, Taylor B, Crenshaw A, Gabriel S, Minguez B, Iavarone M, Friedman SL, Colombo M, Llovet JM, Golub TR. Prognostic gene expression signature for patients with hepatitis C-related early-stage cirrhosis. Gastroenterology 2013; 144:1024-30. [PMID: 23333348 PMCID: PMC3633736 DOI: 10.1053/j.gastro.2013.01.021] [Citation(s) in RCA: 166] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 01/10/2013] [Accepted: 01/13/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Cirrhosis affects 1% to 2% of the world population and is the major risk factor for hepatocellular carcinoma (HCC). Hepatitis C cirrhosis-related HCC is the most rapidly increasing cause of cancer death in the United States. Noninvasive methods have been developed to identify patients with asymptomatic early-stage cirrhosis, increasing the burden of HCC surveillance, but biomarkers are needed to identify patients with cirrhosis who are most in need of surveillance. We investigated whether a liver-derived 186-gene signature previously associated with outcomes of patients with HCC is prognostic for patients with newly diagnosed cirrhosis but without HCC. METHODS We performed gene expression profile analysis of formalin-fixed needle biopsy specimens from the livers of 216 patients with hepatitis C-related early-stage (Child-Pugh class A) cirrhosis who were prospectively followed up for a median of 10 years at an Italian center. We evaluated whether the 186-gene signature was associated with death, progression of cirrhosis, and development of HCC. RESULTS Fifty-five (25%), 101 (47%), and 60 (28%) patients were classified as having poor-, intermediate-, and good-prognosis signatures, respectively. In multivariable Cox regression modeling, the poor-prognosis signature was significantly associated with death (P = .004), progression to advanced cirrhosis (P < .001), and development of HCC (P = .009). The 10-year rates of survival were 63%, 74%, and 85% and the annual incidence of HCC was 5.8%, 2.2%, and 1.5% for patients with poor-, intermediate-, and good-prognosis signatures, respectively. CONCLUSIONS A 186-gene signature used to predict outcomes of patients with HCC is also associated with outcomes of patients with hepatitis C-related early-stage cirrhosis. This signature might be used to identify patients with cirrhosis in most need of surveillance and strategies to prevent the development of HCC.
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Affiliation(s)
- Yujin Hoshida
- Mount Sinai Liver Cancer Program, Tisch Cancer Institute, Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Augusto Villanueva
- HCC Translational Research Laboratory, Barcelona Clinic Liver Cancer Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer Centro de Investigaciones en Red de Enfermedades Hepáticas y Digestivas, Hosptial Clínic Barcelona, Barcelona, Spain
| | - Angelo Sangiovanni
- Department of Medicine, 1 Division of Gastroenterology, Fondazione IRCCS Maggiore Hospital, Università degli Studi di Milano, Milan, Italy
| | - Manel Sole
- Department of Pathology, Barcelona Clinic Liver Cancer Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer Centro de Investigaciones en Red de Enfermedades Hepáticas y Digestivas, Hosptial Clínic Barcelona, Barcelona, Spain
| | - Chin Hur
- Massachusetts General Hospital, Boston, MA
| | | | | | - Joshua Gould
- Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, MA
| | - Kensuke Kojima
- Mount Sinai Liver Cancer Program, Tisch Cancer Institute, Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Supriya Gupta
- Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, MA
| | - Bradley Taylor
- Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, MA
| | - Andrew Crenshaw
- Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, MA
| | - Stacey Gabriel
- Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, MA
| | - Beatriz Minguez
- Mount Sinai Liver Cancer Program, Tisch Cancer Institute, Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Massimo Iavarone
- Department of Medicine, 1 Division of Gastroenterology, Fondazione IRCCS Maggiore Hospital, Università degli Studi di Milano, Milan, Italy
| | - Scott L. Friedman
- Mount Sinai Liver Cancer Program, Tisch Cancer Institute, Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Massimo Colombo
- Department of Medicine, 1 Division of Gastroenterology, Fondazione IRCCS Maggiore Hospital, Università degli Studi di Milano, Milan, Italy
| | - Josep M. Llovet
- Mount Sinai Liver Cancer Program, Tisch Cancer Institute, Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
- HCC Translational Research Laboratory, Barcelona Clinic Liver Cancer Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer Centro de Investigaciones en Red de Enfermedades Hepáticas y Digestivas, Hosptial Clínic Barcelona, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
| | - Todd R. Golub
- Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, MA
- Children’s Hospital, Harvard Medical School, Boston, MA
- Howard Hughes Medical Institute
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Bhogal H, Sterling RK. Staging of liver disease: which option is right for my patient? Infect Dis Clin North Am 2013; 26:849-61. [PMID: 23083819 DOI: 10.1016/j.idc.2012.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
It is important to assess the stage of liver fibrosis in chronic hepatitis C to guide treatment decisions. Liver biopsy has limitations in staging fibrosis. Several blood tests, algorithms, and imaging tests have been studied as noninvasive markers to stage fibrosis in hepatitis C. In patients without suspicion for cirrhosis, 2 noninvasive methods can be used to predict presence of absence of significant liver fibrosis; however, liver biopsy remains the gold standard. It is imperative not to miss the diagnosis of cirrhosis, because this has further implications for screening of hepatocellular carcinoma and varices.
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Affiliation(s)
- Harjit Bhogal
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA, USA
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Friedrich-Rust M, Buggisch P, de Knegt RJ, Dries V, Shi Y, Matschenz K, Schneider MD, Herrmann E, Petersen J, Schulze F, Zeuzem S, Sarrazin C. Acoustic radiation force impulse imaging for non-invasive assessment of liver fibrosis in chronic hepatitis B. J Viral Hepat 2013; 20:240-7. [PMID: 23490368 DOI: 10.1111/j.1365-2893.2012.01646.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Accepted: 06/01/2012] [Indexed: 12/11/2022]
Abstract
Acoustic radiation force impulse (ARFI) imaging is a novel ultrasound-based elastography method that is integrated in a conventional ultrasound machine. It might provide an alternative method to transient elastography for the noninvasive assessment of liver fibrosis. While previous studies have shown comparable diagnostic accuracy of ARFI to transient elastography in chronic hepatitis C, the aim of the present prospective multicenter study was to evaluate ARFI for the assessment of liver fibrosis in chronic hepatitis B. ARFI imaging involves the mechanical excitation of tissue using short-duration acoustic pulses to generate localized displacements in tissue. The displacements result in shear-wave propagation which is tracked using ultrasonic, correlation-based methods and recorded in m/s. In the present international prospective study, patients infected with chronic hepatitis B received ARFI imaging, blood tests and if available transient elastography. The results were compared to liver biopsy as reference method analysed by a central pathologist. In 92 of 114 patients, a comparison of ARFI with transient elastography was possible. ARFI imaging and transient elastography correlated significantly with histological fibrosis stage. The diagnostic accuracy expressed as areas under ROC curves for ARFI imaging and transient elastography was 0.75 and 0.83 for the diagnosis of significant fibrosis (F ≥ 2), 0.93 and 0.94 for the diagnosis of severe fibrosis (F ≥ 3), and 0.97 and 0.93 for the diagnosis of liver cirrhosis, respectively. No significant difference was found between ARFI and transient elastography. ARFI imaging is a reliable ultrasound-based method for the assessment of advanced stages of liver fibrosis in chronic hepatitis B.
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Affiliation(s)
- M Friedrich-Rust
- Department of Internal Medicine 1, J.W. Goethe-University Hospital, Frankfurt, Germany.
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Kim BK, Fung J, Yuen MF, Kim SU. Clinical application of liver stiffness measurement using transient elastography in chronic liver disease from longitudinal perspectives. World J Gastroenterol 2013; 19:1890-1900. [PMID: 23569334 PMCID: PMC3613104 DOI: 10.3748/wjg.v19.i12.1890] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 09/28/2012] [Indexed: 02/06/2023] Open
Abstract
Accurate determination of the presence and degree of fibrosis in liver is of great importance, because the prognosis and management strategies for chronic liver disease depend mainly on these factors. To date, liver biopsy (LB) remains the “gold standard” for assessing the severity of liver fibrosis; however, LB is often limited by its invasiveness, sampling error, and intra/inter-observer variability in histological interpretation. Furthermore, repeated LB examinations within a short time interval are indeed ineligible in a real clinical practice. Thus, due to the pressing need for non-invasive surrogates for liver fibrosis, transient elastography (TE), as a novel ultrasound based technology, has allowed a noninvasive measurement of liver stiffness and has gained in popularity over recent years. In the past few years, additional roles for transient TE beyond the initial purpose of a non-invasive surrogate for LB have included the prediction of the most two critical consequences of fibrosis progression: the development of portal hypertension-related complications and hepatocellular carcinoma. This indicates that the role of transient TE is not merely limited to reducing the need for LB, but transient TE can enable the establishment of tailored management strategies by providing more detailed prognostic information. In particular, under the concept in which the clinical course of liver fibrosis is dynamic and bidirectional, especially when appropriate intervention is commenced, transient TE can be used to track the dynamic changes in fibrotic burden during antiviral or antifibrotic treatment. This review discussed extended applications of transient TE in prediction of the development of real clinical endpoints from a longitudinal perspective.
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