DOES MILD HEPATITIS ON LIVER BIOPSY WARRANT IMMEDIATE COMBINATION ANTI VIRAL THERAPY IN CHRONIC HEPATITIS C PATIENTS?
Abstract
Background: Not all patients with histologically mild chronic Hepatitis C progress to cirrhosis.Many patients being treated on the basis of raised ALT and positive PCR alone may not beactually requiring it. Methods: All adult patients suffering from chronic Hepatitis C, qualifyingfor combination interferon ribavirin therapy, under went liver biopsies. Tissue samples were sentto Armed Forces Institute of Pathology (AFIP) Rawalpindi for histopathology. Reporting wasdone according to modified Ishaq score. Results: Total number of patients was 147. Out of these,75 (51%) were female and 72 (49%) were male. Mean age of females and males were 35.1±8.12and 36.31±8.56 year respectively. Out of these, 19 (12.9%) were stage zero, 61 (41.5%) at stage 1,and 31 (21.1%) at stage 2 of modified fibrotic Ishaq score. In all, 111 (75.5%) of the patients were≤2 of modified Ishaq fibrotic score in either sex or 80 (54.4%) ≤1 of modified Ishaq fibrotic stage.The necroinflammatory score has been divided into minimal (0–3), mild (4–8), moderate (9–13),and severe (14–18). About the same number of our patients (74%) had minimal to mildinflammation. Conclusion: Since the majority of the patients have fibrotic score less than 3, so itwill be cost effective to individualise their treatment on liver histpathology. Patients with lowfibrotic score and minimal to mild inflammation may not be treated, but only monitored withserial ALT and liver biopsy every 4–5 years. Treatment may be started if there is increase infibrosis on surveillance biopsy. However, there is a need to conduct prospective studies in similargroup of patients to evaluate the natural course of disease in untreated patients.Keywords: liver biopsy, chronic liver disease, HAI score, HCVReferences
Luby SP, Qamruddin K, Shah AA, Omair A, Pasha O, Khan
AJ, et al. The relationship between therapeutic injections and
high prevalence of hepatitis C infection in Hafizabad,
Pakistan. Epidemiol Infect 1997;119:349–56.
Tong, MJ, El-Farra, NS, Reikes, AR, Co, RL. Clinical
outcomes after transfusion-associated hepatitis C. N Engl J
Med 1995;332:1463–6.
Takahashi, M, Yamada, G, Miyamoto, R, Doi, T, Endo, H,
Tsuji, T, et al. Natural course of chronic hepatitis C. Am J
Gastroenterol 1993;88:240–3.
Yano, M, Kumada, H, Kage, M, Ikeda, K, Shimamatsu, K,
Inoue, O, et al. The long-term pathological evolution of
chronic hepatitis C. Hepatology 1996;23:1334–40.
Kenny-Walsh, E. Clinical outcomes after hepatitis C infection
from contaminated anti-D immune globulin. N Engl J Med
;340:1228–33.
Levine RA, Sanderson SO, Ploutz-Snyder R, Murray F, Kay
E, Hegarty J, et al. Assessment of fibrosis progression in
untreated Irish women with chronic hepatitis C contracted
from immunoglobulin anti-d. Clin Gastroenterol Hepatol
;4:1271–7.
Davis GL, Lau JY. Factors predictive of a beneficial response to
therapy of hepatitis C. Hepatology 1997;26(suppl 1):122S–127S.
Poynard T, Marcellin P, Lee SS, Niederau C, Minuk GS, Ideo
G, Bain V, et al. Randomised trial of interferon alpha2b plus
ribavirin for 48 weeks or for 24 weeks versus interferon alpha2b
plus placebo for 48 weeks for treatment of chronic infection
with hepatitis C virus. International Hepatitis Interventional
Therapy Group (IHIT). Lancet 1998;352:1426–32.
Salomon JA, Weinstein MC, Hammitt JK, Goldie SJ, Costeffectiveness of treatment for chronic hepatitis C infection in
an evolving patient population. JAMA 2003;290:228–37.
Khokhar N, Jadoon H A. Percutaneous liver biopsy using
spinal needle. Pak J Gastroenterol 2002;16(1):9–11.
Jadoon HA. Liver biopsy with spinal (lumber puncture)
needle-A Cheaper alternative. J Ayub Med Coll Abbottabad
;12(1):13–5.
Sheikh NI, Ahmed SI, Zaheer S, Fatima SA. Evaluation of
liver biopsy as a safe procedure carried out in day surgery
setting. J Rawal Med Coll 2004;8(2):69–71.
Seeff, LB. Natural history of hepatitis C. Hepatology
;26:21S–28S.
