Page 40 - The Flying Publisher Guide to Hepatitis C Treatment

40 | Hepatitis C Treatment

scores and Fibroscan™ are being developed in order to provide a
more accurate fibrosis stage classification (Boursier 2011).

Correlation between biochemical, histological and
virological markers and HCV treatment

Patients should have serum transaminases (ALT and AST) levels
monitored at one month, and then every 3 months, following
initiation of therapy. Mild to moderate fluctuations in liver
enzyme levels are common in persons with chronic HCV
infection, and in the absence of signs and/or symptoms of liver
disease they do not require interruption of antiviral therapy.
Significant elevation in liver enzymes levels – more than 5 times
the upper limit of normal – should prompt careful evaluation for
liver insufficiency and for alternative causes of liver injury.
Eventually, withdrawal of antiviral treatment may be required.
A high baseline VL correlates with higher fibrosis and necrosis-
inflammation scores (Mallet 2008). In patients with histologically
proven cirrhosis without esophageal varices, successful
treatment, as defined by a SVR, is associated with a reduction in
decompensation, occurrence of HCC and mortality (Bruno 2007).
The Child-Pugh (CP) classification of patients with HCV-induced
cirrhosis is used in predicting the likelihood of SVR rate after
antiviral therapy (AISF 2009):
– Patients with “histologically proven” cirrhosis without
esophageal varices (Child class A5 to 6), identified by stages
5 and 6 of Ishak’s score and stage 4 of the Metavir and
Knodell scores. Presumed SVR rate is 25% in HCV G1 and
75% in non-G1 infected patients.
– Patients with “compensated” cirrhosis with or without
esophageal varices (including Child class B7). Recognized
SVR rate is <15% in HCV G1 and <60% in non-G1 infected
patients.
– Patients with “decompensated” cirrhosis (Child class B8 or
more) defined by any evidence of previous decompensation
(ascites, esophageal bleeding, portal encephalopathy,