A brief review on molecular, genetic and imaging techniques for HCV fibrosis evaluation

Abstract

BackgroundChronic HCV is one of the major causes of morbidity and mortality in the present day world. The assessment of disease progression not only provides useful information for diagnosis and therapeutic supervision judgment but also for monitoring disease. Different invasive and non invasive methods are applied to diagnose the disease from initial to end stage (mild fibrosis to cirrhosis). Although, liver biopsy is still considered as gold standard to identify liver histological stages, an assessment of the disease development based on non-invasive clinical findings is also emerging and this may replace the need of biopsy in near future. This review gives brief insight on non-invasive methods currently available for predicting liver fibrosis in HCV with their current pros and cons to make easier for a clinician to choose better marker to assess liver fibrosis in HCV infected patients.MethodsMore than 200 studies regarding invasive and noninvasive markers available for HCV liver disease diagnosis were thoroughly reviewed. We examined year wise results of these markers based on their sensitivity, specificity, PPV, NPV and AUROCs.ResultsWe found that in all non-invasive serum markers for HCV, FibroTest, Forn's Index, Fibrometer and HepaScore have high five-year predictive value but with low AUROCs (0.60~0.85) and are not comparable to liver biopsy (AUROC = 0.97). Even though from its beginning, Fibroscan is proved to be best with high AUROCs (> 0.90) in all studies, no single noninvasive marker is able to differentiate all fibrosis stages from end stage cirrhosis. Meanwhile, specific genetic markers may not only discriminate fibrotic and cirrhotic liver but also differentiate individual fibrosis stages.ConclusionsThere is a need of marker which accurately determines the stage based on simplest routine laboratory test. Genetic marker in combination of imaging technique may be the better non invasive diagnostic method in future.

13C-Aminopyrine breath test accurately predicts long-term outcome of chronic hepatitis C

“…There are two main groups of non-invasive markers for the evaluation of hepatic fibrosis and its progression: imaging and serum-based markers [23][24][25]. The image techniques are limited in terms of costs, technical complexity, availability, and accuracy.…”

Molecular Serum Markers of Liver Fibrosis

“…Liver fibrosis evaluation methods can be divided into those that are invasive and those that are non-invasive 6. Liver biopsy is an invasive method that has long been regarded as the ‘gold standard’ for staging liver fibrosis.…”

Value of reelin for assessing hepatic fibrogenesis in a group of Egyptian HCV infected patients

“…In addition, serum miR-122 levels as indicator of fibrosis progression in chronic hepatitis C (CHC) infection were investigated [18]. Meanwhile, the result was not completely satisfactory in the attempt to detect a perfect surrogate marker that could completely replace or decrease the need for liver biopsies in monitoring the reversal or progression of fibrosis in patients under close observation or on therapy [14,19,20].…”

“…Cell structure related proteins, proteomic analysis comprising actin, prolyl 4-hydroxylase, tropomyosin, calponin, transgelin, and human microfibril-associated protein 4 (MFAP-4) were evaluated [13]. Also, measurement of liver stiffness by FibroScan elastometry appears to be reliable in identifying significant fibrosis or cirrhosis [14][15][16][17]. In addition, serum miR-122 levels as indicator of fibrosis progression in chronic hepatitis C (CHC) infection were investigated [18].…”