 |
|
|
| |
IS LIVER BIOPSY JUSTIFIED IN HEPATITIS C GENOTYPE 2 AND 3?
|
| |
| |
Paolo Rizzi, Liver Unit, Kings’ College Hospital, London, United Kingdom (Great Britain); Phillip Harrison, Department of Liver Studies and Transplantation, Division of Gene and, London, United Kingdom (Great Britain)
Background: It has been argued that liver biopsy (LB) may not be justified in patients with HCV genotypes 2 and 3, particularly if they have normal transaminase levels, because of their high rate of sustained response (SVR) to antiviral treatment. However, without a LB, cirrhosis may go unrecognised, leading to inappropriate discharge from follow-up and surveillance for hepatocellular carcinoma (HCC).
Aim: Aim of our study was to determine the prevalence of cirrhosis in patients with HCV genotype 2 or 3, with normal or abnormal AST.
Methods: We reviewed the reports of all histological examinations of liver carried out at our institution between 01-01-01 and 31-12-04. These included examination of LB and livers explanted at transplantation (OLT livers). We selected all reports of examinations performed in patients with HCV, and
observed in these the rate of cirrhosis in relation to genotype and AST.
Results:<
We reviewed 9831 reports: HCV accounted for 658/9831 (6.7%) cases. Cirrhosis (Ishak fibrosis stage =6) was diagnosed in 198/658 (30%) cases and only 87/198 (44%) of these reports were from examination of OLT livers. Genotype was available in 440/658 of HCV patients; genotypes 2 or 3 accounted for 179/440 (40,6%) cases.
Of these 179 patients, 60 (33.5%) had cirrhosis; this was diagnosed in 39/60 (65%) cases with LB and 21/60 (35%) from examination of OLT livers. HCC was diagnosed in 9/60 (15%) of patients with genotype 2 or 3 and cirrhosis, and 7 of these were transplanted. 25 of the total number of 198 cirrhotic patients (12.6%) patients had normal AST. Of the subgroup of 60 patients with cirrhosis and genotype 2 or 3, 8 had normal AST: of these, 2 had HCC and underwent OLT.
Conclusions: In the cohort of 179 patients with HCV genotypes 2 or 3, 39 (22%) were cirrhotic on percutaneous LB, of these 8 (4.5%) had normal LFT.< Although
patients with HCV genotype 2 or 3 have a high response rate to antiviral treatment, our data indicate that a significant proportion of these patients have cirrhosis. A finding of infection with HCV genotype 2 or 3 does not diminish the need for LB.
|
|
| |
| |
|
|
|
|
|
