Case Report Ana Carolina Cardoso Hôpital Beaujon – Universite Paris VII - France Hospital Universitario da Universidade Federal do Rio de Janeiro - Brasil

Case Report 57 years old, male 2004: diagnosis of HCV infection Contamination: unknown Genotype 3a, Viral Load: 1 200 000 IU/mL BMI: 28, DM No excessive alcohol intake and tobacco use

Case Report Liver biopsy (2005): A1F1 (METAVIR) Treatment (2005): PEG INF / RBV – NR Poor tolerance Follow-up / not retreated

Case Report Platelets 170 G/L PT 85 % ALT 102 IU/l AST 93 IU/l GGT 220 IU/L BMI: 32 January / 2011 Liver Biopsy ?

Case Report January / 2011 FibroScan® – 11.2 kPa

Case Report January / 2011 FibroScan® – 11.2 kPa

Liver Fibrosis (METAVIR) Case Report FibroScan® (kPa) 8.8 9.6 14.6 Liver Fibrosis (METAVIR) Previous studies showed that ls values strongly correlate with Metavir score for hepatitis c as seen in this slide. The studies determine that ls cut offs for f1/f2/f3/f4 stages are 7.1, 9.5 and 12.5 F0-F1 F2 F3 F4 Ziol et al, Hepatology 2005 7

Case Report – Question 1 FibroScan® is correct ? Liver Biopsy ? What could we conclude ? FibroScan® is correct ? Liver Biopsy ? Another non invasive test ?

Case Report January / 2011 FibroTest – 0.80

Case Report January / 2010 Fibrotest 0.75-1.00 F4 0.73-0.74 F3-F4 Equivalent METAVIR 0.75-1.00 F4 0.73-0.74 F3-F4 0.59-0.72 F3 0.49-0.58 F2 0.32-0.48 F1-F2 0.28-0.31 F1 0.22-0.27 F0-F1 0.00-0.21 F0 FibroTest – 0.80

Case Report Fibrotest 0.75-1.00 F4 0.73-0.74 F3-F4 0.59-0.72 F3 Equivalent METAVIR 0.75-1.00 F4 0.73-0.74 F3-F4 0.59-0.72 F3 0.49-0.58 F2 0.32-0.48 F1-F2 0.28-0.31 F1 0.22-0.27 F0-F1 0.00-0.21 F0 Alpha-2 macroglobulin Total Bilirubin Gamma GT Apolipoprotein A1 Haptoglobin Imbert-Bismuth et al. Lancet 2001; 357: 2069-75

Case Report – Question 2 FibroScan® and Fibrotest 3/6 months later ? What should we propose ? FibroScan® and Fibrotest 3/6 months later ? Liver biopsy ? Start new treatment immediately ?

Case Report Platelets 181 G/L PT 90 % ALT 133 IU/L AST 88 IU/L GGT 130 IU/L BMI 30 IU/L July / 2011

Case Report July / 2011 FibroScan® – 12.0 kPa / 1.2 / 100% FibroTest – 0.78

Case Report – Liver Biopsy Liver fragment – 20 mm and 12 portal tracts PT CV No difference in comparison with previous liver biopsy L.B: STEATOHEPATITIS + Hep C Metavir A0F1

Case Report FibroTest (n=8524) False Positives False Negatives Hemolysis Haptoglobin < 0.30 g/l Gilbert Bilirubin >17 µmol/l GGT< 30 UI/l Sepsis False Positives False Negatives Inflammation Haptoglobin > 2.0g/l Poynard et al. Clin Chem 2004; 8: 1344-55

Case Report FibroScan® (n=13 369) Obesity (BMI > 30) Limited operator experience Female Age > 52 ys Diabetes Hypertension Limitations Castera et al. Hepatology 2010;51: 828-35

STEATOSIS AND LIVER STIFFNESS P < 0.001 6.2 8.5 Nao tem impacto negativo na performance diagnostica Cardoso et al [abstract]. Hepatology International 2010

STEATOSIS DETECTION USING CAP Beaugrand et at. JVH 2011

STEATOSIS DETECTION USING CAP T = 236 dB/m, Se=0.83, Sp=0.73 T = 255 dB/m, Se=0.94, Sp=0.63 T = 282 dB/m, Se=0.95, Sp=1 Cardoso et al, AASLD 2010

Case Report Take-Home Messages FibroScan® and some serum markers are good tools for non invasive evaluation of liver fibrosis and can avoid liver biopsy in many cases. However discordance can occurs in 25% 10% of the discordances do not have an explanation Liver biopsy persist as the best standart for these cases

Case Report Fibrotest 0.75-1.00 F4 0.73-0.74 F3-F4 0.59-0.72 F3 Equivalent METAVIR 0.75-1.00 F4 0.73-0.74 F3-F4 0.59-0.72 F3 0.49-0.58 F2 0.32-0.48 F1-F2 0.28-0.31 F1 0.22-0.27 F0-F1 0.00-0.21 F0 Alpha-2 macroglobulin Total Bilirubin Gamma GT Apolipoprotein A1 Haptoglobin Imbert-Bismuth et al. Lancet 2001; 357: 2069-75

Castera et al, J Hepatol 2008; 48: 835-47 11/04/2017 Case Report 10 validated measures Success rate > 60% Results are expressed in kPa. The median Only procedures with 10 validated measurements and a success rate of at least 60% and a IQR < 30% of the median value are considered reliable. 11.2 0.9 14.6 IQR < 30% median Castera et al, J Hepatol 2008; 48: 835-47 24