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How Often Should You Do a Liver Biopsy?
Reported by Jules Levin
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The authors performed biopsies after an average 16 years of having HCV, the
2nd biopsy an average of 3.5 years later, and the third biopsy an average of
2.77 years later. The authors conclude progression seems to accelerate in
later stages. While the optimal interval has yet to be defined, it is likely
to be at least five years. My reading of this abstract is that waiting 5
years may be too long for a percentage of people particularly if you've had
HCV for a long time.
editorial note: for persons with HCV/HIV coinfection, HIV accelerates HCV and
although there are no studies I know of looking at this question, you may
want to consider rebiopsy after 1 or 2 years if you have postponed therapy.
DEFINING THE OPTIMAL INTERVAL BETWEEN LIVER BIOPSIES FOR CLINICAL DECISION
MAKING REGARDING INITIATING HCV THERAPY : RATE OF DISEASE PROGRESSION IN HCV
DISEASE
abstract 212
Jean-Pierre Zarski, Ctr Hospitalier Univ de Grenoble, Grenoble France;
Richard Garcia-Kennedy, Pacific Med Ctr, San Francisco; Jean-Pierre
Bronowicki, Ctr Hospitalier Univ, Nancy France; John Mac Hutchinson, Scripps
Clinic, San Diego; Enkelejda Hodaj, Ctr Hospitalier Univ, Grenoble France;
Truta Brandusa, Teresa Wright, Veteran's American Hosp, San Francisco; Robert
Gish, Pacific Med Ctr, San Francisco
Background : In clinical practice, treatment is often deferred in patients
with mild disease, yet the interval at which liver biopsy should be repeated
is not defined.
Aims : In order to address this issue, we examined the rate of fibrosis
progression in patients in whom two or more liver biopsies were available for
review in the absence of therapy. Methods : Two hundred and twenty patients
(131 M, 89 F, mean age : 42 ± 12 years) with histologically proven chronic
hepatitis C were selected in 5 hospital centers (3 in USA and 2 in France),
having at least 2 liver biopsies and no treatment. Liver histology was
assessed according to the Metavir scoring system by a single pathologist.
The mean duration of disease at the first biopsy was 15 ± 9 years. The mean
delay between the biopsies was 3.51 ± 2.06 years [median : 3 (1 - 8)], and
2.77 ± 1.60 [median : 2 (1 6)] in the 18 patients having 3 biopsies.
Fourteen variables were included in a uni and multivariate analysis in order
to determine factors associated with liver fibrosis progression.
Results : At the first biopsy, the distribution was F0 32 %, F1 33 %, F2 19
%, F3 10 %, F4 6 %. The mean fibrosis progression rate per year was 0.10 ±
0.18 [median 0.07 (0 0.57)] at the first biopsy, 0.07 (0 - 0.57),0.07 ±
0.40 [median : 0.00 (- 81 - + 0.95)] between the first and the second biopsy
and 0.36 ±0.45 [median : 0.17 (0 - 1.5)] (p = 0.07) between the second and
the third biopsy. The difference was not statistically significant. In
univariate analysis, age at infection, age at biopsy, mode of contamination,
alcohol consumption, BMI, high viral load, log AST and log ALT were
associated with severe fibrosis (F3 F4). However, in multivariate analysis,
only age at the first biopsy > 40 years (OR = 5) (2 12) and alcohol
consumption : 1 to 50 g per day (OR = 4) (2 12) and more than 50 g per day
(OR = 8) (3 23) were associated with severe fibrosis (F3 F4). Between
the 2 biopsies only 16 (8.%) patients achieved "clinically significant
fibrosis progression defined as an increase in fibrosis stage 2 (62.5 % at 5
years, 87.5 % at 6 years). However no variable was associated with this
worsening. 2 / 16 patients worse between first and third biopsy. AST (p <
0.02) was the only variable associated with this worsening.
Conclusions : The interval of 3 years may be inadequate to measure disease
progression. This progression seems to accelerate in later stages. While the
optimal interval has yet to be defined, it is likely to be at least five
years.
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