Profile and value of FIB‐4 in patients with dual chronic hepatitis C and B

Liu, Chun‐Jen; Tseng, Tai‐Chung; Yang, Wanting; Su, Tung‐Hung; Yang, Hsiao-Ching; Liu, Chen–Hua; Chen, Pei‐Jer; Chen, Ding‐Shinn

doi:10.1111/jgh.14455

Cited by 11 publications

(6 citation statements)

References 34 publications

(63 reference statements)

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“…The adverse effect of HCV/HBV co-infection has been demonstrated previously by a long-term community-based study in Taiwan showing the combined effect of HCV/HBV co-infection on the cumulative incidence of HCC [9]. Our recent hospital-based cohort study echoed the adverse impact of HCV/HBV co-infection on liver disease progression [21,22]. During a 10-year follow-up, 111 co-infected patients had a higher risk of HCC and cirrhosis than 111 patients with HBV mono-infection, with the hazard ratio of 3.6 and 2.5, respectively [22].…”

Section: Clinical Outcomes and Predictors Of Hcv/hbv Co-infectionsupporting

confidence: 70%

“…The fibrosis 4 parameters (FIB-4) index has been investigated widely for the assessment of the liver fibrosis stage and the clinical outcomes in patients with chronic hepatitis C [21]. To examine the value of FIB-4 in patients with HCV/HBV co-infection, we retrospectively enrolled 152 non-cirrhotic patients with chronic HCV/HBV co-infection: 56 patients receiving pegIFN/RBV therapy and 96 patients being untreated.…”

Section: Clinical Outcomes and Predictors Of Hcv/hbv Co-infectionmentioning

confidence: 99%

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Hepatitis C Virus and Hepatitis B Virus Co-Infection

Shih¹,

Liu

2020

Viruses

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Hepatitis C virus (HCV) and hepatitis B virus (HBV) co-infection can be encountered in either virus endemic countries. Co-infection can also be found in populations at risk of parenteral transmission. Previous studies demonstrated a high risk of liver disease progression in patients with HCV/HBV co-infection; thus, they should be treated aggressively. Previous evidence recommended therapy combining peginterferon (pegIFN) alfa and ribavirin for co-infected patients with positive HCV RNA. Recent trials further advise using direct-acting antivirals (DAAs) for the clearance of HCV in the co-infected patients. Reactivation of HBV has been observed in patients post-intervention, with higher risks and earlier onset in those having had HCV cured by DAA- versus pegIFN-based therapy. The mechanism of HBV reactivation is an interesting but unsolved puzzle. Our recent study revealed that in vitro HBV replication was suppressed by HCV co-infection; HBV suppression was attenuated when interferon signaling was blocked. In vivo, the HBV viremia, initially suppressed by the presence of HCV super-infection, rebounded following HCV clearance by DAA treatment and was accompanied by a reduced hepatic interferon response. In summary, major achievements in the treatment of HCV/HBV co-infection have been accomplished over the past 20 years. Future clinical trials should address measures to reduce or prevent HBV reactivation post HCV cure.

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Section: Clinical Outcomes and Predictors Of Hcv/hbv Co-infectionsupporting

confidence: 70%

Section: Clinical Outcomes and Predictors Of Hcv/hbv Co-infectionmentioning

confidence: 99%

Hepatitis C Virus and Hepatitis B Virus Co-Infection

Shih¹,

Liu

2020

Viruses

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“…Hepatic fibrosis is the early histological change before the development of cirrhosis which is the end sequela in many liver diseases (e.g., hepatitis B or hepatitis C virus infection, chronic alcoholism, and nonalcoholic fatty liver disease (NAFLD)) [ 2 ]. Noninvasive liver fibrosis scores have been developed to screen the extent of liver fibrosis (e.g., fibrosis-4 (FIB-4), NAFLD fibrosis score (NFS), and aspartate aminotransferase to platelet ratio index (APRI)) in chronic liver diseases and validated to use as prognostic indicators [ 3 , 4 ], for NAFLD [ 5 , 6 ], liver cancer [ 7 ], and patients infected with chronic hepatitis virus [ 8 ]. Moreover, they were also identified as diagnostic indicators in other population, such as the general population or patients with established cardiovascular diseases [ 6 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Liver Fibrosis Scores and Hospitalization, Mechanical Ventilation, Severity, and Death in Patients with COVID-19: A Systematic Review and Dose-Response Meta-Analysis

Liu

Mei²,

Tan

et al. 2022

Canadian Journal of Gastroenterology and Hepatology

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Background and Aim. The relationship between liver fibrosis scores and clinical outcomes in patients with COVID-19 is not compressively assessed. Methods. We identified relevant cohort studies that assessed the relationship between liver fibrosis scores (e.g., FIB-4, NAFLD fibrosis score (NFS), and aspartate aminotransferase to platelet ratio index (APRI)) and associated prognosis outcomes by searching the PubMed, EMBASE, and medRxiv databases. The potential dose-response effect was performed using a stage robust error meta-regression. Results. Sixteen studies with 8,736 hospitalized patients with COVID-19 were included. One-point score in FIB-4 increase was significantly associated with increased mechanical ventilation (RR: 2.23, 95% CI: 1.37–3.65, P = 0.001 ), severe COVID-19 (RR: 1.82, 95% CI: 1.53–2.16, P < 0.001 ), and death (RR: 1.47, 95% CI: 1.31–1.65, P < 0.001 ), rather than hospitalization (RR: 1.35, 95% CI: 0.72–2.56, P = 0.35 ). Furthermore, there is a significant positive linear relationship between FIB-4 and severe COVID-19 ( P nonlinearity = 0.12 ) and mortality ( P nonlinearity = 0.18 ). Regarding other liver scores, one unit elevation in APRI increased the risk of death by 178% (RR: 2.78, 95% CI: 1.10–6.99, P = 0.03 ). Higher NFS (≥−1.5) and Forns index were associated with increased risk of severe COVID-19 and COVID-19-associated death. Conclusion. Our dose-response meta-analysis suggests high liver fibrosis scores are associated with worse prognosis in patients with COVID-19. For patients with COVID-19 at admission, especially for those with coexisting chronic liver diseases, assessment of liver fibrosis scores might be useful for identifying high risk of developing severe COVID-19 cases and worse outcomes.

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“…In these patients, HBV-DNA was detected even among HBsAg negative patients (occult HBV infection)[ 72 , 73 ]. The co-infection with both viruses increases the rates of cirrhosis and HCC[ 74 , 75 ]. When both HBV and HCV are present in the same cell, reciprocal inhibition of one viral genome by the other virus takes place and leads to the dominance of one virus over the other.…”

Section: Impact Of Direct-acting Antiviral Regimens On Hcv Infectionmentioning

confidence: 99%

Impact of direct-acting antiviral regimens on hepatic and extrahepatic manifestations of hepatitis C virus infection

Salama¹,

Raslan²,

Abdel‐Latif³

et al. 2022

WJH

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Hepatitis C virus (HCV) is a common cause of liver disease and is associated with various extrahepatic manifestations (EHMs). This mini-review outlines the currently available treatments for HCV infection and their prognostic effect on hepatic manifestations and EHMs. Direct-acting antiviral (DAA) regimens are considered pan-genotypic as they achieve a sustained virological response (SVR) > 85% after 12 wk through all the major HCV genotypes, with high percentages of SVR even in advanced fibrosis and cirrhosis. The risk factors for DAA failure include old males, cirrhosis, and the presence of resistance-associated substitutions (RAS) in the region targeted by the received DAAs. The effectiveness of DAA regimens is reduced in HCV genotype 3 with baseline RAS like A30K, Y93H, and P53del. Moreover, the European Association for the Study of the Liver recommended the identification of baseline RAS for HCV genotype 1a. The higher rate of hepatocellular carcinoma (HCC) after DAA therapy may be related to the fact that DAA regimens are offered to patients with advanced liver fibrosis and cirrhosis, where interferon was contraindicated to those patients. The change in the growth of pre-existing subclinical, undetectable HCC upon DAA treatment might be also a cause. Furthermore, after DAA therapy, the T cell-dependent immune response is much weaker upon HCV clearance, and the down-regulation of TNF-α or the elevated neutrophil to lymphocyte ratio might increase the risk of HCC. DAAs can result in reactivation of hepatitis B virus (HBV) in HCV co-infected patients. DAAs are effective in treating HCV-associated mixed cryoglobulinemia, with clinical and immunological responses, and have rapid and high effectiveness in thrombocytopenia. DAAs improve insulin resistance in 90% of patients, increase glomerular filtration rate, and decrease proteinuria, hematuria and articular manifestations. HCV clearance by DAAs allows a significant improvement in atherosclerosis and metabolic and immunological conditions, with a reduction of major cardiovascular events. They also improve physical function, fatigue, cognitive impairment, and quality of life. Early therapeutic approach with DAAs is recommended as it cure many of the EHMs that are still in a reversible stage and can prevent others that can develop due to delayed treatment.

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Profile and value of FIB‐4 in patients with dual chronic hepatitis C and B

Abstract: In Taiwanese patients coinfected with HCV and HBV, FIB-4 index helps identify patients at risk of developing adverse events, even in patients receiving pegylated interferon/ribavirin therapy.

Cited by 11 publications

References 34 publications

Hepatitis C Virus and Hepatitis B Virus Co-Infection

Hepatitis C Virus and Hepatitis B Virus Co-Infection

Liver Fibrosis Scores and Hospitalization, Mechanical Ventilation, Severity, and Death in Patients with COVID-19: A Systematic Review and Dose-Response Meta-Analysis

Impact of direct-acting antiviral regimens on hepatic and extrahepatic manifestations of hepatitis C virus infection

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