Indirect Serum Fibrosis Markers in Hepatitis C Virus (HCV) Infection

Assessment of liver fibrosis is important for making treatment decisions, as wellas for predicting prognosis and therapeutic outcome in patients on chronichemodialysis (HD) treatment and infected with hepatitis C virus (HCV). Theaim of the present investigation was to evaluate changes in standard laboratorytests (AST, ALT, ãGT, cholesterol and platelet count) and indirect serum fibrosismarkers: AST-to-platelet ratio index (APRI), FIB-4 and Forns index, in chronicallyHCV-infected patients on maintenance HD with and without antiviral treatment.Patients and methods: A total of 38 patients on chronic HD program more than 3months and with chronic hepatitis C, were included in the study. According to locallegislature 14 patients receive antiviral therapy (24 or 48 weeks, according to HCVgenotype) adjusted for patients on HD: eight of them achieved sustained virologicalresponse (SVR) and six did not. Results: All treated patients were HCV genotype1. Baseline blood samples for standard laboratory tests and indirect serum fibrosismarkers were collected on the day of antiviral treatment initiation, as well as at theend of follow-up treatment, 36 month later. At the beginning of antiviral treatmentthere were no significant differences in APRI, FIB-4, Forns and its components betweenpatients who will achieve SVR and those who did not. A significant decrease ofAST, ALT, ãGT and APRI, and moderate decrease FIB-4 and Forns index was foundat the end of follow-up in patients with SVR. In non-sustained responders groupthose three indexes and its components remained unchanged. Using cut-of values forAPRI and FIB-4 (APRI 0,5 and FIB-4 1,45) it was registered that raised percentageof patients with “no fibrosis” at the end of follow-up in those who achieved SVR.Absence of fibrosis measured by Forns index remained unchanged in all groups ofpatients. Conclusion: Simple indexes as APRI and FIB-4, successfully decrease afterantiviral treatment of chronic hepatitis C in hemodialysis patients. These parametersseems to be useful in monitoring for liver fibrosis rate after antiviral treatment inpatients on maintenance HD infected by HCV and can be used for estimation liverfibrosis progression in candidates for cadaveric renal transplantation.