Case%20report

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Case report

• Paul Calès
• Conflict of interest FibroMeter

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• Man, 45 year old in 2001
• October 2001 HCV serology ?
• January 2002
• AST 69, ALT 121 UI/l
• HCV RNA ?
• HCV genotype 4c/4d

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• 15/3/02
• Liver biopsy
• 2 fragments 12 mm x 2
• Metavir A2 F2

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• October 2002
• IFN 150 µg x 3/w RIBA 1 g/d for 1 year
• January and September 2003 HVC RNA ? responder

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• 2004 HCV RNA ? relapser
• 2004-7
• No treatment for HCV
• follow-up

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Follow-up by non-invasive tests
Fibroscan M (IQR) (kPa) FibroMeter InflaMeter
24/06/04 7.7 0.65
18/10/05 6.3 0.69
10/10/06 6.3 0.78 0.81
13/11/07 6.4 (0.6) 0.65 0.67
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Fibroscan interpretation

• Meta-analysis of Tsochatzis et al (J Hepatol
  201154650-9).
• Patient F0/1

Metavir kPa
F0/1 7.2
F2 7.3 FS 10.1
F3 10.2 FS 14.9
F4 15.0
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FibroMeter interpretation

• Boursier J, BMC Gastroenterol 2011
• Patient F21

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Questions (1)

• What is your diagnosis for fibrosis staging?
• What to do?

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• 10/4/08
• HCV RNA 5.1 Log UI/ml
• AST 39, ALT 66 UI/ml
• Liver biopsy
• 2 fragments 3 mm x 2
• Metavir A2/3 F2/3

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Questions (2)

• What is your diagnosis for fibrosis staging?
• What to do?

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• 17/6/08
• Liver biopsy under US guidance
• 2 fragments 7 20 mm
• Double reading
• Metavir A2 F2
• Ishak grade 7, stage 2

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• Inclusion in the ANRS study HC 29
• Irbesartan vs placebo for 2 years in Metavir F2
  or F3 HCV pts who refuse or have
  contra-indication or no indication to SOC
  treatment (IFN Riba).

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• 23/9/10
• Liver biopsy
• 1 fragment 39 mm
• Double reading
• Metavir A2 F2
• Ishak grade 6, stage 3

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Overview on follow-up of liver lesions
Fibroscan M (IQR) (kPa) FibroMeter CombiMeter CirrhoMeter InflaMeter Metavir
15/03/02 A2 F2
24/06/04 7.7 0.65
18/10/05 6.3 0.69
10/10/06 6.3 0.78 0.81
13/11/07 6.4 (0.6) 0.65 0.67
10/04/08 6.9 (0.04) A2 F2
15/09/09 5.8 (0.09)
23/09/10 7.7 (2.6) A2 F2
13/12/11 5.6 (0.9) 0.70 (F21) 0.53 (F21) 0.14 0.57
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Follow-up results of non-invasive markers
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Dynamic sensitivity of tests in natural history
of hepatitis C
FibroMeter
Fibroscan
Year 3 vs year 1 plt10-3
Year 3 vs year 1 p0.410
Calès, Clin Biochem 2010
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Dynamic reproducibility of tests in natural
history of hepatitis C
FibroMeter
Fibroscan
Year 3 vs 1 ric0.44
Year 3 vs 1 ric0.83
Calès, Clin Biochem 2010
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Dynamic reproducibility (2 years) of mesures of
liver lesions
Fibrosis
Activity
Histological mesure Blood test
Calès, J Viral Hepatitis 2012
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Comparaison of liver histology, morphometry and
blood tests to assess fibrosis progression
Histology
Blood tests

• 101 pts with HCVHIV
• Follow-up 96 w

The area of fibrosis was the sole histological
characteristic with a significant change ().

CirrhoMeter was the only blood test with a
significantly higher change than that of area of
fibrosis (p0.039).

CirrhoMeter
Area of fibrosis
significant change
Calès, J Viral Hepatitis 2012
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b
a
P 0.003
P 0.020
From Calès, J Viral Hepatitis 2012
ric 0.815
ric 0.826
c
d
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Agreement between biopsies
From Calès, J Viral Hepatitis 2012
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Conclusion

• Considering non-invasive tests in HCV hepatitis,
  blood test and elastometry have the advantage to
  be independent methods.
• In case of discrepant results, two solutions
• Another third examination like liver biopsy
• Or test combination
• For follow-up, certain blood test(s) could be
  more reproducible and more sensitive to detect
  small changes than other examinations.

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BU
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New tests
1 0
CirrhoMeter Accuracy 87
CombiMeter FibroMeter Fibroscan Accuracy 92
Boursier EJGH 2009 Boursier Hepatology 2012