Page 38 - The Flying Publisher Guide to Hepatitis C Treatment

38 | Hepatitis C Treatment

With a cutoff value of about 7-8 kPa, it can identify about 70% of
patients with histological signs of moderate to severe fibrosis.
With a cutoff of 14-15 kPa, it can identify about 85% of patients
with histological signs of cirrhosis.
Transient elastography is less reliable in ruling out moderate
fibrosis. The results are less certain in patients with a thick chest
wall, hepatic congestion of cardiac origin and acute
exacerbations of hepatitis. However, it has improved the ability
to define the extent of fibrosis without a LB, particularly when
combined with other noninvasive markers.
Biochemical scores are calculated based on panels of multiple
serum markers associated with hepatic fibrosis. Performance of
these measures appears similar in both HCV monoinfected and
HIV-HCV co-infected patients (Shaheen 2008). Several simple
tests are presented in Table 2.5.
Two tests have been specifically designed for HIV-HCV co-
infection: SHASTA index (includes hyaluronic acid, AST and
albumin) (Kelleher 2005) and FIB-4 (ALT and AST level, platelet
count and age) (Sterling 2006).

Table 2.5 – Simple biochemical scores
Test Markers Interpretation
AAR AST to ALT *ratio AST/ALT ≥ 1: significant
(Williams 1998) cirrhosis
APRI AST-platelet ratio APRI < 0.5: no/minimal fibrosis
(Wai 2003) APRI > 1.5: significant fibrosis
Fibrosis Index (FI) Platlet count and serum FI < 2.1: no/ minimal fibrosis
(Ohta 2006) albumin FI ≥ 2.1: significant fibrosis
FI ≥ 3.3: cirrhosis
* AST: aspartate aminotransferase; ALT: alanine aminotransferase

Several composite tests based on mathematical algorithms have
been introduced in practice (Table 2.6).