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Case report Paul Calès Conflict of interest: FibroMeter.

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1 Case report Paul Calès Conflict of interest: FibroMeter

2 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 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 : – No treatment for HCV – follow-up:

6 Follow-up by non-invasive tests Fibroscan M (IQR) (kPa) FibroMeterInflaMeter 24/06/ /10/ /10/ /11/ (0.6)

7 Fibroscan interpretation Meta-analysis of Tsochatzis et al (J Hepatol 2011;54:650-9). Patient: F0/1 MetavirkPa F0/1≤ 7.2 F27.3 ≤ FS ≤ 10.1 F310.2 ≤ 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 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) FibroMeterCombiMeterCirrhoMeterInflaMeterMetavir 15/03/02A2 F2 24/06/ /10/ /10/ /11/076.4 (0.6) /04/086.9 (0.04)A2 F2 15/09/095.8 (0.09) 23/09/107.7 (2.6)A2 F2 13/12/115.6 (0.9)0.70 (F2 ±1 )0.53 (F2 ±1 )

16 Follow-up: results of non-invasive markers

17 Dynamic sensitivity of tests in natural history of hepatitis C FibroMeterFibroscan 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 Calès, Clin Biochem 2010 Year 3 vs 1 r ic =0.83 Year 3 vs 1 r ic =0.44

19 Dynamic reproducibility (2 years) of mesures of liver lesions FibrosisActivity 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 HistologyBlood tests* * * * : significant change Calès, J Viral Hepatitis 2012 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). Area of fibrosis CirrhoMeter

21 P = P = r ic = r ic = a b cd From Calès, J Viral Hepatitis 2012

22 Agreement between biopsies 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 New tests 1 0 CombiMeter: FibroMeter + Fibroscan Accuracy: 92% CirrhoMeter Accuracy: 87% Boursier EJGH 2009 Boursier Hepatology 2012


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