Prospective Risk Analysis of Hepatocellular Carcinoma in Patients with Chronic Hepatitis C by Ultrasound Strain Elastography

2016 ◽  
Vol 34 (6) ◽  
pp. 650-653 ◽  
Author(s):  
Norihisa Yada ◽  
Toshiharu Sakurai ◽  
Tomohiro Minami ◽  
Tadaaki Arizumi ◽  
Masahiro Takita ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Liver Fibrosis ◽  
Liver Cancer ◽  
Chronic Hepatitis C ◽  
Hcv Infection ◽  
Rank Test ◽  
Entire Cohort ◽  
Chronic Hcv

Objective: We have reported about real-time tissue elastography (RTE), which displays relative strain by measuring the relative distortion of the tissue, and found this information to be useful for diagnosing liver fibrosis. However, its use in predicting hepatocellular carcinoma has not been reported as yet. Here, we investigated RTE to predict liver carcinogenesis in patients with chronic hepatitis C virus (HCV) infection. Methods: We enrolled 160 patients with chronic HCV, who were followed up for 39.9 ± 22.9 weeks (median). They underwent RTE and then ultrasounds every 3-6 months. Results: Respective cumulative liver cancer incidences for years 1, 2, 3, 4, and 5 were, for the entire cohort: 2.0, 5.6, 8.8, 13.1, and 23.9%; for those whose liver fibrosis index (LFI) was ≤2.0: 0.0, 0.0, 0.0, 0.0, and 0.0%; for those whose LFI was 2-2.8: 0.0, 7.4, 7.4, 13.2 and 19.9%; and for those whose LFI was >2.8: 12.9, 12.9, 21.7, 31.4, and 31.4% (p = 0.011; log-rank test). Conclusions: Measurements of LFI by strain imaging can effectively predict liver cancer risk in patients with chronic HCV infection.

scholarly journals Factors predicting staging and treatment initiation for patients with chronic hepatitis C infection: insurance a key predictor

2021 ◽  
Author(s):  
Janet Lin ◽  
Cammeo Mauntel-Medici ◽  
Anjana Bairavi Maheswaran ◽  
Sara Baghikar ◽  
Oksana Pugach ◽  
...  
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Liver Fibrosis ◽  
Chronic Hepatitis C ◽  
Treatment Initiation ◽  
Cox Regression ◽  
Hcv Infection ◽  
Inpatient Setting ◽  
Hepatitis C Infection ◽  
Chronic Hcv

Abstract Background Chronic hepatitis C (HCV) infection affects over 2.4 million Americans and accounts for 18 000 deaths per year. Treatment initiation in this population continues to be low even after introduction of highly effective and shorter duration direct-acting antivirals. This study assesses factors that influence key milestones in the HCV care continuum. Methods Retrospective time-to-event analyses were performed to assess factors influencing liver fibrosis staging and treatment initiation among individuals confirmed with chronic HCV infection at University of Illinois Hospital and Health Sciences System between 1 August 2015 and 24 October 2016 and followed through 28 January 2018. Cox regression models were utilized for multivariable analyses. Results Individuals tested at the liver clinic (hazard ratio [HR] = 2.03; 95% confidence interval [CI]: 1.19–3.46) and at the federally qualified health center (HR = 3.51; 95% CI: 2.19–5.64) had higher instantaneous probability of being staged compared with individuals tested at the emergency department (ED) or inpatient setting. And probability of treatment initiation increased with advancing liver fibrosis especially for Medicaid beneficiaries (HR = 1.64; 95% CI: 1.35–1.99). Conclusions The study demonstrates a need for improving access for patients with early stages of the disease in order to reduce HCV-related morbidity and mortality, especially those tested at nontraditional care locations such as the ED or the inpatient setting.

scholarly journals Comparative study between two 2D-Shear Waves Elastography techniques for the non-invasive assessment of liver fibrosis in patients with chronic hepatitis C virus (HCV) infection

2021 ◽  
Author(s):  
Victor Bâldea ◽  
Felix Bende ◽  
Alina Popescu ◽  
Roxana Șirli ◽  
Ioan Sporea
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Liver Fibrosis ◽  
Chronic Hepatitis C ◽  
Hcv Infection ◽  
Operating Characteristics ◽  
Non Invasive ◽  
Chronic Hepatitis C Virus ◽  
Chronic Hcv

Aims: We aimed to compare the diagnostic performance of two 2D-Shear Wave Elastography (2D-SWE) techniques for the non-invasive assessment of liver fibrosis in patients with chronic hepatitis C virus (HCV) infection using Transient Elas-tography (TE) as reference. Material and methods: We enrolled 208 consecutive patients with chronic HCV infection, in which liver stiffness (LS) was evaluated in the same session using two 2D-SWE techniques: 2D-SWE.GE and 2D-SWE.SSI using TE as the method of reference. LS measurements were considered failures when no value was obtained after 10 attempts. Results: Valid LSMs were obtained in 95.6% (199/208) of cases by 2D-SWE.GE, 92.7% (193/208) of cases by 2D-SWE.SSI, and in 94.7% (197/208) of cases by TE (p>0.05). The mean LS values by 2D-SWE.GE were significantly lower than those obtained by 2D-SWE.SSI: 10.3±3.8 kPa vs. 15±10.4 kPa (p<0.0001). 2D-SWE.GE LSMs correlated better with TE than 2D-SWE.SSI (r=0.75, p<0.0001 vs. r=0.57, p<0.0001, z test p=0.0012). Linear regression analysis showed a moderate correlation between LSMs obtained by 2D-SWE.GE and 2D-SWE.SSI (r=0.63, R2=0.4, P<0.0001). Pairwise comparison of receiver operating characteristics curves (ROC) found no significant differences between 2D-SWE.GE and 2D-SWE.SSI in identifying F≥2 fibrosis (0.97 vs. 0.96, P = 0.5650), F≥3 (0.97 vs. 0.95, P = 0.2935), or F=4 (0.97 vs. 0.96, p = 0.6914). Conclusions: Both 2D-SWE techniques had good feasibility for the noninvasive assessment of liver fibrosis. LS values obtained by 2D-SWE.GE were significantly lower than those obtained by 2D-SWE.SSI. No significant differences were found between both methods in staging liver fibrosis in patients with chronic HCV.

Genetic polymorphisms as the predictors of response to antiviral treatment in chronic hepatitis C virus infection

2011 ◽  
Vol 152 (22) ◽  
pp. 876-881
Author(s):  
Alajos Pár
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Genetic Polymorphisms ◽  
Chronic Hepatitis C ◽  
Genome Wide Association Study ◽  
Antiviral Treatment ◽  
Hcv Infection ◽  
Snp Analysis ◽  
Chronic Hcv

The review discusses the genetic polymorphisms involved in the pathogenesis of hepatitis C virus (HCV) infection, that may determine the outcome of disease. In this field earlier both certain major histocompatibility complex (MHC) alleles and some cytokine gene variants have also been studied. Recently, the genome-wide association study (GWAS) and targeted single nucleotide polymorphism (SNP) analysis have revealed that a variant in the promoter region of interleukin-28B (IL-28B) gene is strongly linked to viral clearance and it may be the strongest pretreatment predictor of treatment response in chronic hepatitis C. Last year it was shown that two genetic variants leading to inosine triphosphatase deficiency protect against haemolytic anemia in patients receiving ribavirin during antiviral treatment for chronic HCV infection. Orv. Hetil., 2011, 152, 876–881.

scholarly journals Liver Impairment and Hematological Changes in Patients with Chronic Hepatitis C and COVID-19: A Retrospective Study after One Year of Pandemic

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 597
Author(s):  
Bianca Cerbu ◽  
Stelian Pantea ◽  
Felix Bratosin ◽  
Iulia Vidican ◽  
Mirela Turaiche ◽  
...  
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Clinical Outcomes ◽  
Chronic Hepatitis C ◽  
Hcv Infection ◽  
Multivariate Logistic Regression Model ◽  
P Value ◽  
Liver Impairment ◽  
All Cause Mortality ◽  
Chronic Hcv

Background and Objectives: The COVID-19 pandemic is an ongoing public health emergency. Patients with chronic diseases are at greater risk for complications and poor outcomes. The objective of this study was to investigate the liver function abnormalities and clinical outcomes in patients with COVID-19 and chronic hepatitis C. Materials and Methods: This retrospective, single-center study was conducted on a cohort of 126 patients with a history of hepatitis C, confirmed with COVID-19 between 01 April 2020 and 30 December 2020. Several clinical outcomes were compared between patients with active and non-active HCV infection, and the risks of liver impairment and all-cause mortality in active HCV patients were analyzed using a multivariate logistic regression model. Results: Among 1057 patients under follow-up for chronic HCV infection, 126 (11.9%) were confirmed with COVID-19; of these, 95 (75.4%) were under treatment or achieved SVR, while in the other 31 (24.6%), we found active HCV replication. There was a significantly higher proportion of severe COVID-19 cases in the active HCV group as compared to the non-active HCV group (32.2 vs. 7.3%, p < 0.001). Multivariate analysis showed that age, sex, alanine aminotransferase, C-reactive protein, procalcitonin, and HCV viral load were significant independent risk factors for liver impairment and all-cause mortality. The length of stay in hospital and intensive care unit for COVID-19 was significantly higher in patients with active HCV infection (p-value < 0.001), and a higher proportion of these patients required mechanical ventilation. Conclusions: Active HCV infection is an independent risk factor for all-cause mortality in COVID-19 patients.

scholarly journals Serum Inter-Alpha-Trypsin Inhibitor Heavy Chain 4 (ITIH4) in Children with Chronic Hepatitis C: Relation to Liver Fibrosis and Viremia

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Mostafa M. Sira ◽  
Behairy E. Behairy ◽  
Azza M. Abd-Elaziz ◽  
Sameh A. Abd Elnaby ◽  
Ehab E. Eltahan
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Liver Fibrosis ◽  
Chronic Hepatitis C ◽  
Heavy Chain ◽  
Trypsin Inhibitor ◽  
Clinical Laboratory ◽  
Treatment Naïve ◽  
Liver Fibrogenesis ◽  
Chronic Hcv

Liver fibrosis and viremia are determinant factors for the treatment policy and its outcome in chronic hepatitis C virus (HCV) infection. We aimed to investigate serum level of inter-alpha-trypsin inhibitor heavy chain 4 (ITIH4) and its relation to liver fibrosis and viremia in children with chronic HCV. ITIH4 was measured by ELISA in 33 treatment-naive children with proved chronic HCV and compared according to different clinical, laboratory and histopathological parameters. Liver histopathological changes were assessed using Ishak score and compared with aspartate transaminase-to-platelet ratio (APRI) and FIB-4 indices as simple noninvasive markers of fibrosis. ITIH4 was measured in a group of 30 age- and sex-matched healthy controls. ITIH4 was significantly higher in patients than in controls (54.2±30.78 pg/mL versus 37.21±5.39 pg/mL; P=0.021). ITIH4, but not APRI or FIB-4, had a significant direct correlation with fibrosis stage (P=0.015, 0.961, and 0.389, resp.), whereas, the negative correlation of ITIH4 with HCV viremia was of marginal significance (P=0.071). In conclusion, ITIH4 significantly correlated with higher stages of fibrosis indicating a possible relation to liver fibrogenesis. The trend of higher ITIH4 with lower viremia points out a potential antiviral properties and further studies in this regard are worthwhile.

scholarly journals Newer molecules and new hopes in the management of chronic hepatitis C

JMS SKIMS ◽  
2010 ◽  
Vol 13 (2) ◽  
pp. 39-40
Author(s):  
Showkat Ali Zargar
Keyword(s):  
Hepatocellular Carcinoma ◽  
Immune Response ◽  
Liver Transplantation ◽  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Chronic Hepatitis C ◽  
Chronic Infection ◽  
Antiviral Therapies ◽  
Chronic Hcv Infection ◽  
Chronic Hcv

Chronic hepatitis C is highly prevalent with prevalence rate of around 3% involving about 180 million people worldwide, despite major advances in its understanding of viral 1 pathogenesis and significant evolution in antiviral therapies. Most of the patients develop chronic infection because the virus evades the host immune response in majority of patients. Chronic HCV infection can lead to cirrhosis and hepatocellular carcinoma. Complications of HCV-related cirrhosis are the leading indication for liver transplantation in United States and Europe...... J Med Sci 2010;13(2): 39-40.

The Role of Retinol Binding Protein 4 (RBP4) in Prediction of Response to New Direct Acting Antiviral Drugs (DAAS) in Chronic Hepatitis C

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohammed Abd Elfattah Elmalatawy ◽  
Khaled Zakaria Elqarmoty ◽  
Hany Samir Rasmy ◽  
Ebrahim Youssef Abdelwarth
Keyword(s):  
Hepatocellular Carcinoma ◽  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Chronic Hepatitis C ◽  
Outpatient Clinic ◽  
Predictive Value ◽  
Test Accuracy ◽  
Normal Person ◽  
Prediction Of Response ◽  
Chronic Hcv

Abstract Background Hepatitis c virus is global health burden and major health hazard in Egypt, since the virus is the etiological factor of chronic hepatitis that frequently progress to a cirrhosis and hepatocellular carcinoma (HCC). In addition to cirrhosis and hepatocellular carcinoma, HCV is thought to cause metabolic alterations, including steatosis, dyslipidemia, insulin resistance (IR), diabetes, obesity, and cardiovascular events. Objective To determine the value of RPB4 in the prediction of response to new DAAS treatment in chronic HCV infected patients and to correlate its level with the metabolic profile and fibrosis degree among chronic HCV Patients and Methods This study was Prospective cohort clinical study that was conducted at hepatology and virology outpatient clinic at Ain Shams University Hospital &Hepatology and virology outpatient clinic at Kafr –El Sheikh liver institute from January 2019 to October 2019 after informed consent. Results The present study showed that the best level of RBP4 in prediction of hepatic fibrosis stage 4 was ≤ 46 pg/ml and had sensitivity of 100% while the specificity was 66.67%.The positive predictive value was 50%while the negative predictive value was 100% and test accuracy was 80.5%. Conclusion Serum RBP4 was found to be higher in chronic hepatitis C naïve patients than normal person; there was significant reduction of RBP4 post treatment. Fibroscan showed marked reduction of fibrosis degree after treatment with Directly acting antiviral in both cirrhotic and noncirrhotic patients regardless the treatment regimen used with improved overall liver function tests, liver enzymes and platelet count in patients who reached SVR and maintained negative PCR after treatment.

scholarly journals Liver Biopsies for Chronic Hepatitis C: Should Nonultrasound-Guided Biopsies Be Abandoned?

2009 ◽  
Vol 23 (6) ◽  
pp. 425-430 ◽  
Author(s):  
Jennifer A Flemming ◽  
David J Hurlbut ◽  
Ben Mussari ◽  
Lawrence C Hookey
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Liver Biopsy ◽  
Chronic Hepatitis C ◽  
Hcv Infection ◽  
Significant Difference ◽  
The Us ◽  
Chronic Hcv Infection ◽  
Liver Biopsies ◽  
Chronic Hcv

BACKGROUND/OBJECTIVE: Liver biopsy has been the gold standard for grading and staging chronic hepatitis C virus (HCV)-mediated liver injury. Traditionally, this has been performed by trained practitioners using a nonimage-guided percutaneous technique at the bedside. Recent literature suggests an expanding role for radiologists in obtaining biopsies using an ultrasound (US)-guided technique. The present study was undertaken study to determine if the two techniques produced liver biopsy specimens of similar quality and hypothesized that at our institution, non-US-guided percutaneous liver biopsies for HCV would be of higher quality than US-guided specimens.METHODS: Liver biopsies from 100 patients with chronic HCV infection (50 consecutive US-guided and 50 consecutive non-US-guided), were retrospectively identified using a hospital histopathology database. All original biopsy slides were coded and prospectively reanalyzed by a single hepatopathologist who was blinded to the technique used in obtaining the biopsy. Additionally, all liver biopsies for chronic HCV infection completed at the centre from 1998 to 2007 were identified and the technique used was recorded. Biopsy quality was determined primarily by the number of complete portal tracts (CPTs) identifiable in the slides. The total length of specimen and the degree of fragmentation were secondary outcome measures.RESULTS: There was a slight difference observed between the US-guided and non-US-guided groups in mean age (46.3 years versus 42.5 years, repectively; P=0.018) but no differences in sex, presence of cirrhosis, bilirubin, creatinine, international normalized ratio, and grade or stage of disease. Biopsies obtained using the US-guided technique produced higher quality specimens than the non-US-guided technique based on our primary outcome of number of CPTs in the biopsy (11.8 versus 7.4; P<0.001). US-guided specimens also were longer (24.4 mm versus 19.7 mm; P=0.001), had less fragmentation (P=0.016), and a higher overall histopathological quality assessment (P=0.026) than the non-US-guided biopsies. However, there was no significant difference between the two groups in the ability to grade and stage the disease (96% US-guided versus 90% in non-US-guided (P=0.20). Over a 10-year period, 763 biopsies for chronic HCV infection were identified with an obvious trend toward the increased use of US-guided technique observed at 2% in 1998 to 85% in 2007.CONCLUSIONS: US-guided liver biopsies for chronic HCV are the most common method of obtaining specimens at the Kingston General Hospital, Kingston, Ontario, and are of higher quality than non-US-guided specimens. However, there is no significant difference in the two techniques in the ability to grade and stage chronic HCV.

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