Poster Presentations

Session Title: VIRAL HEPATITIS - f) HEPATITIS C – CLINICAL (EXCEPT THERAPY)
Presentation Date: Apr 23, 2009

PAIRED BIOPSY COMPARISON OF TWO LIVER FIBROSIS MARKER PANELS (HCV FIBROTEST, HEPASCORE) IN FOLLOWING HISTOLOGICAL RESPONSE TO ANTIVIRAL THERAPY FOR CHRONIC HEPATITIS C (CHC)

A. Thompson, L. Elliott, H. Tillmann, J. McHutchison, K. Patel
Duke Clinical Research Institute, Duke University Medical Centre, Durham, NC, USA

Background: Non-invasive methods that follow changes in liver fibrosis after antiviral or antifibrotic therapy could provide an alternative to liver biopsy for the assessment of histological endpoints for CHC patients.
Aim: To independently evaluate the performance characteristics of FibroTest (FT) and HepaScore (HS) panels in following changes in liver fibrosis in pre- and post-treatment biopsies in a single center patient cohort.
Methods: FT and HS were independently and blindly evaluated in serum obtained from 134 CHC patients, matched to biopsies pre- and 6 months post- IFN-based therapy. METAVIR stage was scored by expert histopathologists at our center.
Results: Baseline fibrosis prevalence was: F0 (13%), F1 (52%), F2 (11%), F3 (13%) and F4 (11%). All biopsies included > 6 portal tracts (median length 13 mm, IQR 11-15). For detecting F2-4, FT and HS had sensitivity 0.62 v. 0.71, specificity 0.60 v. 0.62, and AUROC 0.65 v. 0.74, respectively (p=NS). METAVIR scores post-treatment were unchanged in 61%, decreased by 1F stage in 14% and increased by 1F stage in 13%. Agreement between the change in METAVIR score and change in either FT or HS was poor (Kappa=0.003 and 0.07) (Figure 1). A significant correlation between change in FT and change in ALT was observed (r=0.41, p< 0.001). This relationship was weaker for HS and ALT (r=0.17, p=0.05). For FT, SVR (n=43), but not non-response (n = 91), led to a significant decrease in index score (SVR: mean decrease in FT=0.06±0.10; p< 0.001). Virological response was not associated with a significant change in HS.
Conclusion: In this cohort, the performance characteristics of both FT and HS were relatively poor for selection of F2-4 at baseline, and for detecting changes in fibrosis stage after therapy. Changes in marker index scores following antiviral therapy correlated with inflammation (ALT) and treatment outcome (SVR), especially for FT.


[Figure 1]