Liver fibrosis evaluation and reproducibility for HCV patients

Serum markers (SM) and elastometry have been evaluated against liver biopsy (LB) in Western countries. Similar evaluation was required in Egypt, where HCV genotype distribution (mostly genotype 4) differs from that in Europe, where co-infection with hepatitis B virus or S.mansoni may be present in up to 5% of HCV-infected patients, where liver steatosis is common, and where patients have an elevated body mass index. Although elastometry and some serum markers may appear too costly or impractical for most treatment facilities in Egypt, their use may be considered within the 23 National Treatment Centres. Also, as cost-effectiveness studies have suggested not treating patients with F1 METAVIR fibrosis stage (see above), a simple and non invasive tool will be necessary to monitor progression of liver fibrosis until treatment becomes indicated.


The objective of this study was to compare elastometry (Fibroscan®) and SM (APRI, Fib4 and Fibrotest®) with LB in Egypt. Recruited patients coming for pre-treatment evaluation at the National Treatment Reference Centres in Cairo underwent a liver biopsy, a liver stiffness evaluation (Fibroscan®), and a blood sampling for the calculation of the Fibrotest, the Fib4 score and the APRI score. In total, 474 patients were enrolled in this study, but 162 were excluded for inadequate biopsies. 

Additional analysis was performed on 58 of these patients to assess the reproducibility of liver stiffness measurement (Fibroscan®). Two operators evaluated liver stiffness by Fibroscan® two times per patient the same day, and the intra- and inter-reproducibility was assessed using different methods (Bland and Altman graphics, variation coefficient, intraclass correlation coefficient and Kappa coefficient). The results showed a notable percentage of discordance, especially in the intermediate fibrosis stages F1-F2 (Vignier et al., J Viral Hepatitis, 2011). 


Note: This research has been completed and results will be updated here soon.


Back to Past Research


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fp7_01fp7_02 This project is funded
by the European Union