Diagnostic utility of viral load and biochemical markers in chronic hepatitis C viral infection associated with hepatic fibrosis

ABSTRACT

The role of liver biopsy in management of patients with chronic hepatitis C is currently being depated. A liver biopsy is most often preserved for those considering treatment in order to assess the grade and stage of hepatitis. Several non invasive markers of hepatic fibrosis have been evaluated for their ability to assess liver histology. The aim of this study is to assess the degree of hepatic fibrosis as evaluated by liver biopsy and ultrasonography in relation to serum HCV-RNA viral load, routine biochemical and haemotological markers. The study was carried out during the period 2005-2006 it included 20 chronic HCV out patient who attended the Out Clinic of Hepatology Unit Faculty of Medicine and Medical Research Institute Alexandria University. Patients were clinically evaluated and tested for the presence of anti-HCV by ELISA, HCV-RNA by quantitative Real Time PCR. A panel of routine biochemical tests includes [ALT, AST, GGT, serum albumin, serum cholesterol, prothrombin activity and platelet count was carried out. Core liver biopsies were taken from all 20 patients under U/S guidance. This study shows 11 [55%] out of 20 chronic HCV patients has no significant fibrosis by Metavir staging [F0-F2].while the remaining 9 [45%] had significant fibrosis [F3-F4] The viral load did not correlate with the degree of liver fibrosis. Platelets and albumin were significantly associated with the presence of significant fibrosis 90% of the HCV patients with no significant fibrosis and prothrombin activity act >/= 80%. A platelet count below 150x109/L was associated with significant fibrosis while or platelet count more than 150x109 does not exclude its presence. By using the APRI index [AST/platelet] all patients with significant fibrosis have a score less than one while a score more than 2 is associated with significant fibrosis. A score less than 2 in the API [Age/platelets] was favor of the absence of significant fibrosis while the score of 6 was associated with significant fibrosis by using Forns index 88.9% of patients with significant fibrosis has a cut-off value higher than 2 while all patients with no significant fibrosis has a cut-off value less than 6.9. By using [ALT/AST] ratio 72% of patients with no significant fibrosis had a ratio less than one. Our results confirm the NIH consensus status of 2002 had no single non invasive test or panel of serological markers can provide an accurate assessment of the intermediate stage of liver fibrosis indicating that non invasive tests could not replace the information provided by liver biopsy