1. Paul Calès Conflict of interest: FibroMeter
Case report
Paul Calès
Conflict of interest: FibroMeter

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

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

4. January and September 2003: HVC RNA : responder
October 2002:
IFN 150 µg x 3/w + RIBA 1 g/d for 1 year
January and September 2003: HVC RNA : responder

5. 2004: HCV RNA : relapser
2004-7:
No treatment for HCV
follow-up:

6. 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
0.78
0.81
13/11/07
6.4 (0.6)
0.67

7. Fibroscan interpretation
Meta-analysis of Tsochatzis et al (J Hepatol 2011;54:650-9).
Patient: F0/1
Metavir
kPa
F0/1
≤ 7.2 F2
7.3 ≤ FS ≤ 10.1 F3
10.2 ≤ FS ≤ 14.9 F4
≥ 15.0

8. FibroMeter interpretation
Boursier J, BMC Gastroenterol 2011
Patient: F2±1

9. Questions (1)
What is your diagnosis for fibrosis staging?
What to do?

10. 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

11. Questions (2)
What is your diagnosis for fibrosis staging?
What to do?

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

13. 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).

14. 23/9/10 Liver biopsy: 1 fragment: 39 mm Double reading: Metavir: A2 F2
Ishak: grade 6, stage 3

15. 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
0.78
0.81
13/11/07
6.4 (0.6)
0.67
10/04/08
6.9 (0.04)
15/09/09
5.8 (0.09)
23/09/10
7.7 (2.6)
13/12/11
5.6 (0.9)
0.70 (F2±1)
0.53 (F2±1)
0.14
0.57

16. Follow-up: results of non-invasive markers

17. Dynamic sensitivity of tests in natural history of hepatitis C
FibroMeter
Fibroscan
Year 3 vs year 1: p<10-3
Year 3 vs year 1: p=0.410
Calès, Clin Biochem 2010

18. Dynamic reproducibility of tests in natural history of hepatitis C
FibroMeter
Fibroscan
Year 3 vs 1
ric=0.83
Year 3 vs 1
ric=0.44
Calès, Clin Biochem 2010

19. Dynamic reproducibility (2 years) of mesures of liver lesions
Fibrosis
Activity
Histological mesure Blood test
Calès, J Viral Hepatitis 2012

20. Comparaison of liver histology, morphometry and blood tests to assess fibrosis progression
101 pts with HCV±HIV
Follow-up: 96 w
Histology
Blood tests *
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 (p=0.039). *
CirrhoMeter
Area of fibrosis
Calès, J Viral Hepatitis 2012
* : significant change 20

21. a b c d P = 0.003 P = 0.020 From Calès, J Viral Hepatitis 2012
ric = 0.815
ric = 0.826 c d

22. Agreement between biopsies
Résultats 5 Fibrosistop.spo
From Calès, J Viral Hepatitis 2012

23. 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.

24. BU

25. CombiMeter: FibroMeter + Fibroscan
New tests
1 0
CirrhoMeter
Accuracy: 87%
CombiMeter: FibroMeter + Fibroscan
Accuracy: 92%
Boursier EJGH 2009
Boursier Hepatology 2012