Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Struber, G.
Relation of hepatic activity index and fibrosis with liver function tests in patients with chronic hepatitis C
[ Dissertation ] Medical University of Graz; 2004. pp.
- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Lackner Karoline
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- Abstract:
- Introduction: Chronic infection with the HCV is one of the most common causes of chronic liver disease in the western world. Up to 20% of patients develop cirrhosis of the liver during a time course of 20 years after infection. Among the patients with liver cirrhosis, the annual rate of hepatocellular carcinoma ranges form 1 to 7%. However, due to advances in modern antiviral treatment, HCV can be eliminated in 45-80% of patients. Yet, considerable side effects of antiviral treatment occur in most of the patients and cause discontinuation of treatment in approximately 10 to 14% of patients. Therefore, indication for antiviral treatment has to be carefully evaluated. According to the treatment guidelines of the NIH consensus conference statement of management of hepatitis C in 2002, antiviral treatment is recommended for patients with an increased risk of developing cirrhosis. Most of these patients have persistently elevated ALT labels. However, approximately 30% of patients with chronic hepatitis C exhibit normal of only slight elevated ALT serum levels below 2 times the upper limit of normal (ULN). Those patients are thought to be at lower risk for development of cirrhosis. In fact, most exhibit only mild inflammation and fibrosis histologically. In this subgroup of patients, benefit from antiviral therapy is till a matter of debate. Because the degree of hepatic inflammation (grade9 and fibrosis (stage) cannot reliably be predicted by liver function tests of other serological routine parameters, liver biopsy and histological evaluation of grade and stage are important tolls in antiviral therapy decision making. However, liver biopsy is an invasive procedure that may cause undersirable events, such as pain in 20 to 30% of the cases, major complications in 0,5 and even death in 0,03%. Moreover, not all patients, particularly those with coagulopathies, are candidates for a liver biopsy. In the face of these risk factors and the side effects of antiviral treatment, non-invasive tests to estimate grade and stage of chronic hepatitis C are desired for clinical practice. Different scoring systems for the assessment of grade and stage have been proposed, for example the histological activity index of Knodell et al., the Scheuer system, the Metavir algorithm and the modified histological activity index (HAI) and modified staging of Ishak et al. Latter is thought to be more detailed than the other existing systems of liver function.