DOES MILD HEPATITIS ON LIVER BIOPSY WARRANT IMMEDIATE COMBINATION ANTI VIRAL THERAPY IN CHRONIC HEPATITIS C PATIENTS?
AbstractBackground: 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, HCV
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
Takahashi, M, Yamada, G, Miyamoto, R, Doi, T, Endo, H,
Tsuji, T, et al. Natural course of chronic hepatitis C. Am J
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
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
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
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
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.