Non Invasive Assessment of Hepatic Fibrosis and Necro-inflammatory Activity in Pediatric Patients with Chronic Hepatitis C Virus Infection: A Pilot Study of the Role of FibroTest and ActiTest in Children

Abstract

Hepatitis C virus (HCV) is a major cause of chronic hepatitis and hepatic fibrosis. The overall sero-prevalence in Egyptian children in two cross sectional studies from Southern and Northern Egypt were 8.7% and 24.3% respectively. Finding the best method to evaluate and manage children infected with HCV continues to be a challenge. Liver biopsy, due to its limitations and risks, is an imperfect gold standard for assessing the severity of the most frequent chronic liver diseases. Noninvasive alternatives to liver biopsy in patients infected with HCV include 2 combinations of simple serum biochemical markers: FibroTest (FT) for the assessment of fibrosis, and ActiTest (AT) for the assessment of necro-inflammatory activity. Although, the uses of FT and AT have been validated in adults with chronic HCV infection and is probably of great benefit, yet, there is lack of relevant data concerning their role in pediatric patients. In this pilot study, we attempted to verify the possibility of implementation of FT and AT as non invasive markers in assessment of the degree of hepatic fibrosis and necro-inflammatory activity in pediatric patients with chronic HCV infection in comparison to liver biopsy. Fifty patients, aged 2.0-18.0 years (with a mean of 10.52 ±4.83 years), with chronic HCV infection were studied. Two assessments have been done, within 24-hour-duration, one of a liver biopsy specimen and the other with FT and AT measured in serum sample. A highly significant linear trend between FT related fibrosis and fibrosis stage by histopathological examination was found (p value<0.0005). A highly significant correlation was also found between both parameters (r=0.811). As well, a highly significant correlation was found between AT and necro-inflammatory histological activity index (HAI) with r=0.591 and p<0.0005. FT and AT are potential non-invasive methods for assessment of hepatic fibrosis and necro-inflammatory activity in pediatric patients with chronic HCV infection.