Biopsy Unnecessary for Successful Hepatitis C Treatment
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This article reports on a study that shows biopsy need not be required to treat chronic Hepatitis C. The statistically significant results show that other indicators (ultrasound, fibrosis blood tests, etc.) can suffice when measuring liver damage and treatment success. Because biopsy is an invasive medical procedure with known risks, proceeding successfully without biopsy would be a preferred approach. Also of note in this report are the success rates. Sustained virologic response was seen in 41 to 43.6% of patients. I keep seeing results like this and can’t help wondering how the common knowledge (and that preached by most doctors) is better than a 50% success rate.
Treatment of Patients with Chronic Hepatitis C with or without Liver Biopsy
Expert consensus recommends liver biopsy before therapy for chronic hepatitis C. A cost effectiveness analysis suggested that the best strategy in the management of patients was to treat without biopsy.
In this study, researchers compared therapy in patients who did, or did not undergo biopsy.
Hepatitis C virus (HCV)-positive patients (78) who did not agree to (n = 57) or with contraindications to liver biopsy (n = 21) (group A) were matched for age, sex and genotype with those who consented (group B).
Before therapy (interferon/ribavirin for 12 months), all patients must have received a clinical diagnosis of chronic hepatitis, on the basis of standard biochemical and ultrasonographic parameters. The two groups showed similar baseline characteristics.
A noninvasive, diagnosis of chronic hepatitis was made in 75.6% of group A, and in 83.3% of group B (P = 0.26). Concordance between clinical and histological diagnosis in group B amounted to 91%.
End-of-therapy virological response was 52.6% in group A, and 57.7% in group B (P = 0.63). Sustained virological response was 41.0% and 43.6% in the two groups (P = 0.87).
Predictors of sustained response were noninvasive diagnosis of chronic hepatitis (P = 0.006), lack of portal hypertension (P = 0.037), platelets >105/mm3 (P = 0.007), prothrombin >70% (P = 0.02), and genotype 2 or 3 (P < 0.0001). At multivariate analysis, genotype (P < 0.0001) and platelets (P = 0.004) maintained their predictive power.
The authors conclude, “In most patients with HCV infection, virological clearance after therapy can be achieved irrespective of whatever a liver biopsy might show.”
01/19/04
Reference
A Andriulli and others. Treatment of patients with HCV infection with or without liver biopsy. Journal of Viral Hepatitis 11(6): 536-541. November 2004.
