Assessment of Liver Fibrosis in African Americans and Caucasians with Hepatitis C

Patients with chronic hepatitis C virus (HCV) infection may develop advanced liver disease, including cirrhosis and hepatocellular carcinoma. As such, assessment of histological fibrosis stage is an integral part of disease management

As reported in the October 2006 issue of Hepatology, researchers aimed to develop a model incorporating objective clinical and laboratory parameters to estimate the probability of severe fibrosis (i.e., Ishak fibrosis of 3 or higher) in previously untreated African American and Caucasian patients with genotype 1 HCV -- the hardest type to treat.

The Ishak fibrosis scores of 205 Caucasian and 194 African American patients enrolled in the ongoing Viral Resistance to Antiviral Therapy of Chronic Hepatitis C (Virahep-C) study were modeled using simple and multiple logistic regression. The model was then validated in a separate cohort of 461 previously untreated patients with HCV.

Results

The distribution of fibrosis scores was similar in the Caucasian and African American patients, as was the proportion of patients with severe fibrosis (35% vs 39%; P = 0.47).

After accounting for the number of portal areas in the patients' liver biopsies, the following factors were independently associated with severe fibrosis in the overall cohort:
- age;
- serum aspartate aminotransferase (AST) level;
- alkaline phosphatase level;
- platelet count.

The relationship between these factors and fibrosis was similar in both the Caucasian and African American groups.

The area under the receiver operating characteristic curve (AUROC) of the Virahep-C model (0.837) was significantly better than that of other published models (P = 0.0003).

The AUROC of the Virahep-C model was 0.851 in the validation population.

Conclusion

In conclusion, the authors wrote, "a model consisting of widely available clinical and laboratory features predicted severe hepatic fibrosis equally well in African American and Caucasian patients with HCV genotype 1 and was superior to other published models."

They added that, "The excellent performance of the Virahep-C model in an external validation cohort suggests the findings are replicable and potentially generalizable."

Department of Internal Medicine, University of Michigan, Ann Arbor, MI.

10/10/06

Reference
R J Fontana, D E Kleiner, R Bilonick, and others. Modeling hepatic fibrosis in African American and Caucasian American patients with chronic hepatitis C virus infection. Hepatology. 44(4): 925-935. October 2006.