الفهرس 
Hepatitis C InfectionOnly 14 pages are availabe for public view
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Abstract
C
hronic hepatitis C virus (HCV) infection is a major health problem in Egypt with an estimated of 9% countrywide and up to 50% in certain rural areas. Hepatitis C virus (HCV) is also the leading cause of liver cirrhosis and cancer in Egypt.
HCV infection is associated with varying degrees of liver inflammation and progressive fibrosis, which may result in cirrhosis and hepatocellular carcinoma.
The investigators of the AIDS Pegasys Ribavirin International Coinfection Trial (Apricot study), a pivotal trial evaluating the efficacy of pegylated interferon and ribavirin in patients coinfected with HIV and HCV, recently proposed a simple noninvasive test for liver fibrosis known as the FIB-4 using the following formula: (age (years) X AST [U/L]/(platelets [109/L] X (ALT [U/L])1/2).
The main purpose of this study is to evaluate the utility of FIB-4 index as a simple inexpensive non invasive marker to assess liver fibrosis in chronic HCV monoinfection in comparison to transient elastography (TE) (FibroScan).
The current cross sectional study was conducted on 30 patients attending our outpatient clinic at the internal medicine department of Ain Shams University from January 2012 to January 2013 with chronic HCV infection based on clinical, laboratory, and radiological data.
On the whole sample, the mean of FIB-4 index increased with the increase of the fibrosis score, however, the differences were only statistically significant (P <0.05) when groups with cirrhosis (F4) were compared with groups with moderate fibrosis (F1) and intermediate fibrosis (F2). The FIB-4 index could not significantly discriminate F0 from F1 groups, nor F2 from F3.
In our study, the FIB-4 index proved to be sensitive and specific in differentiation between patient with no or mild fibrosis (Metavir F0-F1) and patients with significant fibrosis or cirrhosis (F2-F3-F4) (AUC=91.6) with the best cut off value at 1.61 where sensitivity 69.5% was and specificity was 100%. The positive predictive value was 100% to detect patient with no or mild fibrosis.
The FIB-4 index also proved to be sensitive and specific in differentiation between patient with no or significant fibrosis (Metavir F0-F1-F2-F3) and patients with cirrhosis (Metavir F4) (AUC=90.5) with the best cut off value at 1.88 where sensitivity 84.6% was and specificity was 88.2% .The positive predictive value was 88.2% and the negative predictive value was 100% to exclude patient with cirrhosis.
The FIB-4 index enabled the correct identification of extreme types of fibrosis, because its performance seemed to be reliable when identifying very moderate fibrosis versus more severe forms of the disease.
Using these cutoffs (1.61-1.88), 87% of patients fell outside these ranges and could thus avoid biopsy with an overall accuracy of 70%.
The limitation of FIB-4 index is regarded to the patients who fell in the range between 1.61 and 1.88, thus require liver biopsy or Fibroscan for more accurate classification