The art of predicting fibrosis in hepatitis C

[Non-alcoholic fatty liver disease. How and who to screen]

Non-alcoholic fatty acid disease (NAFLD) can develop in the context of multiple processes but the main etiologic association is undoubtedly with insulin resistance syndrome. The present review aims to provide a systematic diagnostic approach that should include the following basic elements: a) a suspected diagnosis of NAFLD, including confirmation of abstinence from alcohol, exclusion of other potential causes of liver steatosis and diagnosis of potential associated diseases; b) diagnosis of insulin resistance; c) diagnosis of potential associated diseases; d) adequate evaluation of vascular risk; e) diagnosis of the type and localization of fat, and finally, f) evaluation of the severity of NAFLD, which can be performed through invasive and non-invasive techniques.

[Grade of consistency existing in the grade of hepatic fibrosis calculated with the APRI and FORNS biochemistry indexes and transient elastography (Fibroscan in patients coinfected with HIV-HCV]

INTRODUCTION

There are non-invasive diagnostic methods of liver fibrosis that are based on biochemical measurements (such as APRI or Forns) or on transient elastography. This study aims to compare the consistency between them in patients coinfected by the human immunodeficiency virus and the hepatitis C virus.

PATIENTS AND METHODS

An elastography, APRI and Forns were performed for 331 patients to evaluate the consistency between the advanced and low grades of fibrosis. The grades of consistency existing between them were calculated with the kappa coefficient.

RESULTS

The grades of fibrosis calculated by APRI and by Forns provided intermediate results (51.1% and 54.7%, respectively), and these patients were not enrolled in the study. The consistency of the elastography in the advanced grade versus the APRI index was 65% and 75% for the Forns index. When the elastography obtained low grade calculations of fibrosis, the consistency with APRI was 80% and 82.2% with Forns Global consistency was 85.5% and with at least one biochemistry index of 72.1%.

CONCLUSION

In the HIV and HCV coinfected patients, the use of the APRI and Forns biochemistry indexes to calculate grade of liver fibrosis does not successfully classify at least half of the patients. However, in the patients classified as having high or low fibrosis, the consistency between the calculations obtained by elastography and those derived from the APRI and Forns indexes is moderate to high.

Monitoring SCCA-IgM complexes in serum predicts liver disease progression in patients with chronic hepatitis

About 30% of the patients with chronic hepatitis develop a progressive liver disease and one of the most intriguing issues is the detection of noninvasive markers for fibrosis stage and disease progression. High levels of squamous cell carcinoma antigen (SCCA)-immunoglobulin M (IgM) are detectable in hepatocellular carcinoma and their increase in cirrhotic patients can predict tumour development. As SCCA-IgM can also be detectable at low percentages in patients with chronic hepatitis, the aim of this study was to assess SCCA-IgM complexes in relation to disease outcome in this group of patients. An ELISA assay was used to determine the presence of SCCA-IgM in 188 patients with chronic hepatitis and in 100 controls. An additional serum sample was available after a median period of 6 years in 57 untreated patients: these patients were subdivided in group A, including eight patients with a fibrosis score increase > or =2 in a second liver biopsy and group B, including 49 patients without fibrosis progression during a similar follow up. SCCA-IgM complexes were detectable in 63 of 188 (33%) patients but in none of the controls. A significant increase of SCCA-IgM levels over time was observed in patients with fibrosis progression (mean +/- SD: 117 +/- 200 U/mL/year), but not in those without histologic deterioration (mean +/- SD: -8.8 +/- 31 U/mL/year, P < 0.0001). In conclusion, monitoring SCCA-IgM levels over time appears a useful approach to identify patients with chronic hepatitis at higher risk for cirrhosis development.