Correlations of Serum Hepatitis C Virus RNA and Alanine Transaminase With Liver Histopathological Changes in Patients With Chronic Hepatitis C

Rationale for Hepatitis C Virus Treatment During Hematopoietic Stem Cell Transplant in the Era of Novel Direct-Acting Antivirals

BACKGROUND AND AIMS

Untreated hepatitis C (HCV) infection in patients undergoing hematopoietic stem cell transplantation (HSCT) can lead to worse outcomes. Traditionally, HSCT patients infected with HCV would wait until after immune reconstitution to receive HCV therapy, as the oncologic urgency of transplant would not allow time for a full preceding treatment course of HCV therapy. However, in the era of newer direct-acting antivirals (DAAs), we propose that concomitant treatment of HCV while undergoing HSCT is safe and feasible, while keeping in mind potential drug-drug interactions.

METHODS

A literature review was performed to summarize the available data on the impact of HCV on patients undergoing HSCT. Drug-drug interactions for DAA's and pertinent HSCT drugs were evaluated using Lexicomp online® and http://hep-druginteractions.org .

RESULTS

During HSCT, HCV appears to be a conditional risk factor for sinusoidal obstruction syndrome and a potential risk factor for graft versus host disease, both of which are associated with increased mortality. HCV reactivation and exacerbation may impact the use of chemotherapeutics, but available studies haven't shown impact specifically on HSCT. Limited case reports exist but demonstrate safe and effective use DAAs during HSCT. These, along with a drug-drug interaction review demonstrate agents such as sofosbuvir/velpatasvir and glecaprevir/pibrentasvir are promising DAAs for use in HSCT.

CONCLUSION

HCV infection may worsen outcomes for patients undergoing HSCT. Concomitant treatment of HCV during HSCT using newer DAAs appears feasible and may improve patient morbidity and mortality, however large-scale studies are needed to further support this practice.

Self-awareness of hepatitis C infection in the United States: A cross-sectional study based on the National Health Nutrition and Examination Survey

Hepatitis C virus (HCV) is a global health issue with an estimated prevalence of 2.4 to 3 million people in the US and 58 million worldwide. Previous reports from the US have shown that close to half of those with the infection are unaware of their status. Although the current therapy for HCV is very effective, the primary barrier has been the inability to diagnose a large fraction of those infected. We studied public awareness of HCV in the US using National Health Nutrition and Examination Survey data from 2013 to 2020. Our aim was to measure awareness of infection in individuals with HCV and identify possible barriers to diagnosis. In total, 206 individuals with HCV were included in the weighted analysis. The weighted awareness of infection was 60.1%, suggesting that over 0.8 million are unaware nationally. Awareness was significantly low in the Mexican American and Asian populations. Non-US citizens and non-US-born individuals also had poor awareness. The transaminases were more elevated in those unaware of the infection, suggesting their higher risk of liver fibrosis. Although the proportion of infected people aware of their illness has been rising, over 0.8 million are still unaware of their infection and their risk of liver damage. We believe policy measures focused on further intense screening and educational campaigns, particularly in high-risk groups, are vital in realizing the World Health Organization's goal of eliminating HCV as a global health threat.

Diagnostic value of serum cytokeratin-18 in children with chronic liver disease

AIM

This study aimed to assess the diagnostic value of serum cytokeratin-18 (CK-18) in children with chronic liver diseases (CLD) and correlate its serum level with liver histology and other liver biomarkers.

METHODS

This study included two groups, the first group included children with CLD and the second group included healthy matched age and gender subjects as a control group, complete history and clinical examination, and serum CK-18 was measured using the sandwich enzyme-linked immunosorbent assay technique.

RESULTS

Serum concentrations of CK-18 were significantly elevated in CLD patients with mean ± standard deviation (1070.63 ± 699.2 ng/mL) compared to healthy controls mean ± standard deviation (203.95 ± 83.57 ng/mL). CK-18 levels were associated with a change in hepatocyte and portal tract (P = 0.005) as it was elevated with cirrhosis and fibrosis stage (P = 0.02) as it was elevated with moderate and severe fibrosis than mild fibrosis, also it showed a gradual increase in accordance with child Pugh score. There was a positive correlation between CK-18 levels and Total IgG, paediatric end-stage liver disease score and model for end-stage liver disease scores, the best cutoff point of CK-18 was 624 ng/mL, with sensitivity 93.06%, specificity 62.5% and diagnostic accuracy 90.0% for detection of fibrosis.

CONCLUSION

CK-18 could be used as a non-invasive diagnostic marker in children with CLD.

Correlation of biochemical markers and HCV RNA titers with fibrosis stages and grades in chronic HCV-3a patients

INTRODUCTION

Hepatitis C virus (HCV) is one of the most important causes of chronic liver diseases, which include inflammation, fibrosis, cirrhosis and hepatocellular carcinoma. Several factors have been proposed to determine the clinical outcome of HCV infection. The accurate mechanism by which HCV damages the liver remains poorly understood. In chronic hepatitis C patients, the relation between serum biochemical markers, HCV RNA titers and histological liver injury remain controversial.

OBJECTIVES

The aim of this study was to investigate the relation between serum biochemical markers, HCV RNA titers and the degree of liver damage in patients with chronic HCV.

MATERIALS AND METHODS

Liver biopsies were performed on 79 of a total of 100 enrolled patients. The histological activity was evaluated by the METAVER scoring system. HCV RNA quantification was performed by quantitative real-time PCR, and HCV genotyping was performed by nested PCR. Biochemical markers were measured with biochemical instruments.

RESULTS

HCV RNA titers were significantly correlated with aspartate aminotransferase (AST) (P=0.004), alkaline phosphatase (ALP) (P=0.001) and total bilirubin (P=0.012) levels. HCV RNA titers were also significantly correlated with a progression of the fibrosis stage (P=0.000), but no correlation was observed with the change in inflammatory grades. It was observed that bilirubin levels were higher in later fibrosis stages as compared with the initial stage (P=0.000). Results revealed that in different fibrosis stages, the levels of AST (P=0.000), ALP (P=0.000) and alanine aminotransferase (ALT) (P=0.008), the age at diagnosis (P=0.000), the present age (P=0.000) and the BMI (P=0.009) were statistically significant. In the case of the inflammatory grade, levels of bilirubin (P=0.000), ALP (P=0.000), AST (P=0.016) and ALT (P=0.000) were statistically different between the inflammatory grades.

CONCLUSION

Serum HCV RNA titers were correlated with AST, ALP and total bilirubin. Levels of ALT, AST, ALP and bilirubin had significant relation with the liver fibrosis stage and the inflammatory grade in genotype 3a. Hence, our study suggests that AST, ALP and ALT may correlate with liver damage.

Relation of serum insulin-like growth factor-1 (IGF-1) levels with hepatitis C virus infection and insulin resistance

The prospect of the growing worldwide epidemic of hepatitis C virus (HCV) infection and type 2 diabetes mellitus certainly merits attention toward their controversial relationship. Insulin-like growth factor-1 (IGF-1) plays an important role in glucose homeostasis. This study is a cross-sectional study considered as an initial investigation aimed to evaluate the effect of HCV infection on serum IGF-1, as well as to find out whether IGF-1 has a role in development of insulin resistance (IR) in HCV infection. A total of 45 subjects divided into 3 groups were included in the study: chronic HCV-infected patients (15 patients), chronic HCV-infected diabetic patients (15 patients), and diabetic patients without HCV infection (15 patients), along with 15 healthy controls. HCV RNA was quantified using real-time polymerase chain reaction (PCR). Serum IGF-1 levels were measured by enzyme-linked immunosorbent assay (ELISA). Homeostasis model assessment of insulin resistance [HOMA-IR], insulin sensitivity [HOMA-S], and β-cell function [HOMA-β] were determined by previously validated mathematic indexes. Fasting blood glucose, insulin levels, and liver parameters including alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were determined. IGF-1 levels were significantly lower in the 3 patient groups compared with controls (P = 0.001). The HCV group demonstrated high HOMA-IR and HOMA-β with a positive correlation between HOMA-IR and either HOMA-β or fasting insulin (P < 0.001). In addition, a negative correlation was found between IGF-1 levels and both AST and ALT, and HOMA-IR was correlated positively with AST activity (P < 0.05). In HCV patients with detectable viremia, IGF-1 levels were correlated negatively with HOMA-β (P < 0.01) and with HOMA-IR. However, this correlation did not reach statistical significance (P = 0.074). No significant correlation was found between HCV viral load and the studied parameters. In conclusion, low IGF-I levels might have a role in IR among HCV viremic patients.