Loading ...
Sorry, an error occurred while loading the content.

AASLD:How Often Should You Do a Liver Biopsy?

Expand Messages
  • claudine intexas
    NATAP - www.natap.org ... AASLD Dallas, Nov 9-13 Reported by Jules Levin How Often Should You Do a Liver Biopsy? The authors performed biopsies after an
    Message 1 of 1 , Nov 15, 2001
    • 0 Attachment
      NATAP - www.natap.org
      ----------------------

      AASLD
      Dallas, Nov 9-13
      Reported by Jules Levin

      How Often Should You Do a Liver Biopsy?

      The authors performed biopsies after an average 16
      years of having HCV,
      the
      2nd biopsy an average of 3.5 years later, and the
      third biopsy an
      average of
      2.77 years later. The authors conclude progression
      seems to accelerate
      in
      later stages. While the optimal interval has yet to be
      defined, it is
      likely
      to be at least five years. My reading of this abstract
      is that waiting
      5
      years may be too long for a percentage of people
      particularly if you've
      had
      HCV for a long time.

      editorial note: for persons with HCV/HIV coinfection,
      HIV accelerates
      HCV and
      although there are no studies I know of looking at
      this question, you
      may
      want to consider rebiopsy after 1 or 2 years if you
      have postponed
      therapy.

      DEFINING THE OPTIMAL INTERVAL BETWEEN LIVER BIOPSIES
      FOR CLINICAL
      DECISION
      MAKING REGARDING INITIATING HCV THERAPY : RATE OF
      DISEASE PROGRESSION
      IN HCV
      DISEASE

      abstract 212

      Jean-Pierre Zarski, Ctr Hospitalier Univ de Grenoble,
      Grenoble France;
      Richard Garcia-Kennedy, Pacific Med Ctr, San
      Francisco; Jean-Pierre
      Bronowicki, Ctr Hospitalier Univ, Nancy France; John
      Mac Hutchinson,
      Scripps
      Clinic, San Diego; Enkelejda Hodaj, Ctr Hospitalier
      Univ, Grenoble
      France;
      Truta Brandusa, Teresa Wright, Veteran's American
      Hosp, San Francisco;
      Robert
      Gish, Pacific Med Ctr, San Francisco

      Background : In clinical practice, treatment is often
      deferred in
      patients
      with mild disease, yet the interval at which liver
      biopsy should be
      repeated
      is not defined.

      Aims : In order to address this issue, we examined the
      rate of fibrosis
      progression in patients in whom two or more liver
      biopsies were
      available for
      review in the absence of therapy. Methods : Two
      hundred and twenty
      patients
      (131 M, 89 F, mean age : 42 �� 12 years) with
      histologically proven
      chronic
      hepatitis C were selected in 5 hospital centers (3 in
      USA and 2 in
      France),
      having at least 2 liver biopsies and no treatment.
      Liver histology was
      assessed according to the Metavir scoring system by a
      single
      pathologist.

      The mean duration of disease at the first biopsy was
      15 �� 9 years. The
      mean
      delay between the biopsies was 3.51 �� 2.06 years
      [median : 3 (1 - 8)],
      and
      2.77 �� 1.60 [median : 2 (1 ��� 6)] in the 18 patients
      having 3
      biopsies.
      Fourteen variables were included in a uni and
      multivariate analysis in
      order
      to determine factors associated with liver fibrosis
      progression.

      Results : At the first biopsy, the distribution was F0
      32 %, F1 33 %,
      F2 19
      %, F3 10 %, F4 6 %. The mean fibrosis progression rate
      per year was
      0.10 ��
      0.18 [median 0.07 (0 ��� 0.57)] at the first biopsy,
      0.07 (0 -
      0.57),0.07 ��
      0.40 [median : 0.00 (- 81 - + 0.95)] between the first
      and the second
      biopsy
      and 0.36 ��0.45 [median : 0.17 (0 - 1.5)] (p = 0.07)
      between the second
      and
      the third biopsy. The difference was not statistically
      significant. In
      univariate analysis, age at infection, age at biopsy,
      mode of
      contamination,
      alcohol consumption, BMI, high viral load, log AST and
      log ALT were
      associated with severe fibrosis (F3 ��� F4). However,
      in multivariate
      analysis,
      only age at the first biopsy > 40 years (OR = 5) (2
      ��� 12) and alcohol
      consumption : 1 to 50 g per day (OR = 4) (2 ��� 12)
      and more than 50 g
      per day
      (OR = 8) (3 ��� 23) were associated with severe
      fibrosis (F3 ��� F4).
      Between
      the 2 biopsies only 16 (8.%) patients achieved
      "clinically significant
      fibrosis progression defined as an increase in
      fibrosis stage 2 (62.5
      % at 5
      years, 87.5 % at 6 years). However no variable was
      associated with this
      worsening. 2 / 16 patients worse between first and
      third biopsy. AST (p
      <
      0.02) was the only variable associated with this
      worsening.

      Conclusions : The interval of 3 years may be
      inadequate to measure
      disease
      progression. This progression seems to accelerate in
      later stages.
      While the
      optimal interval has yet to be defined, it is likely
      to be at least
      five
      years.

      __________________________________________________
      Do You Yahoo!?
      Find the one for you at Yahoo! Personals
      http://personals.yahoo.com
    Your message has been successfully submitted and would be delivered to recipients shortly.