Relation of ALT and AST levels to the histopathological changes in liver biopsies of patients with chronic hepatitis C genotype 4

Worldwide, Egypt has a high prevalence of adult hepatitis C virus [HCV] infection. Serum alanine aminotransferase [ALT] activity is most commonly measured to assess hepatic disease. The revision of the definition of the normal limits for the ALT level is advisable. The aim of this work was to compare the histopathological changes in the liver tissue biopsies of HCV-infected patients, clinically presenting with ALT levels below normal, based on the conventional, previously used upper limit of normal [ULN] of ALT [40 U/L for men and 30 U/L for women] with the proposed new ULN [30 U/L for men, and 19 U/L for women]. This is a retrospective cross-sectional study. A total of 668 cases of chronic hepatitis C genotype 4 were included. Patients were classified according to grades of histological activity and fibrosis stages [by the Metavir scoring system]. They were also classified into normal and high groups according to the old and new cutoffs of both aspartate transaminase [AST] and ALT levels.The results of our study showed that the serum AST level in our study showed a better correlation with the histopathological changes in liver biopsy rather than ALT, especially when using the old cutoff of the ULN for AST. The serum ALT level in our study [both the old and the new cutoffs] did not show a significant correlation with the histopathological status in the liver biopsies of our patients. This study concluded that the old cutoff of the ULN AST is a better predictor of fibrosis

Hepatic fibrosis and serum alpha-fetoprotein [AFP] as predictors of response to HCV treatment and factors associated with serum AFP normalisation after treatment

Elevated levels of alpha-fetoprotein [AFP] can be seen in patients with chronic hepatitis C [CHC] and liver cirrhosis without hepatocellular carcinoma and were negatively associated with treatment response. However, factors associated with its changes are not identified. We aimed in this study to verify a cut-off value for AFP as a predictor of response to standard of care [SOC] antiviral therapy in Egyptian chronic hepatitis C virus [HCV]-infected patients and identify factors associated with its changes post treatment. A total of 175 chronic non-cirrhotic HCV-infected patients were evaluated for baseline serum AFP and liver biopsy were classified according to Ishak scoring system of hepatic fibrosis. All patients were scheduled to receive SOC antiviral therapy for 48 weeks and had been followed up to week 72. Reassessment of AFP and repeated liver biopsy at week 72 were feasible only in 79 patients. High baseline AFP levels were observed in non-respondents [non-sustained virological respondents [non-SVRs]] [P< 0.01]; the AFP level decreased in all patients post treatment [P= 0.01], especially in the SVRs [P < 0.01]. In multivariate analysis, hepatic fibrosis was a predictor of response to treatment [P=0.02], while body mass index [BMI] [25-30 kg mr[2]], hepatic activity [A2], hepatic fibrosis stage [F2-F4] and fibrosis improvement were predictors of AFP difference [P = 0.007, 0.01, 0.012, <0.001, 0.030, and 0.018], respectively. The diagnostic performance to predict the HCV treatment response was best by adding both AFP and hepatic fibrosis stage factors; the best cut-off value for AFP was 3.57 ng dr1 with 50% sensitivity and 68% specificity with area under the curve [AUC] of 0.55 and for hepatic fibrosis stage was 3, with a sensitivity of 88%, a specificity of 30% with an AUC of 0.58. In chronic HCV-infected patients, serum AFP below 3.57 ng dl[-1] and hepatic fibrosis stage 3 are expected to have good response to treatment; BMI [25-30 kg m[-1]], A2, fibrosis >2 and fibrosis improvement predict AFP change post treatment

Factors associated with fibrosis progression in HCV infected children in Egypt

This study aimed at identification of factors that could be associated with development of hepatic fibrosis in children with HCV infection. The study was carried out at the Pediatric Hepatology Unit, Cairo University Children's Hospital, Egypt. Liver biopsies were obtained from 43 children with HCV infection after having informed consent from their parents in the period "1995-2002". Their mean age at liver biopsy was and 8.67 +/- 4.3 years. Boys: girls ratio was 1.3:1. The results proved that, by examining the 43 patients' biopsies, 12 were having no fibrosis, 20 were having mild fibrosis and 11 were having moderate to severe fibrosis. The median time for development of fibrosis was estimated to be 5.5 years. Developing fibrosis was significantly associated with shorter duration from first detected ALT elevation to biopsy [P =0.015] and having higher levels of direct serum bilirubin [P Value=0.048]. Unexpectedly, development of fibrosis was slower in the group with co- morbid conditions compared to the group with no co-morbid conditions [P =0.04]. The development of hepatic fibrosis in children with HCV infection was associated with shorter duration of first detected ALT elevation to biopsy and higher direct serum bilirubin levels and it was progressing more slowly in the group having co-morbid conditions