Chronic Hepatitis and Liver Fibrosis/Activity

In some patients, Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) are acute, short-term illnesses. However, for the patients who develop chronic hepatitis, proper measurement and treatment of liver damage is essential to avoid the long-term health consequences of cirrhosis, liver cancer and liver failure.

The progression of chronic HBV and HCV infections can be measured through the prognosis of liver fibrosis (scarring) and activity (inflammation).

• Liver fibrosis is the process of scarring through fibrous tissue deposit, which results in destruction of the parenchyma. The ultimate progressive stage of fibrosis is cirrhosis.
• Liver activity estimates the amount of portal inflammation and hepatocellular necrosis provoked by chronic HBV and HCV infections.

HBV or HCV Testing from BioReference®

Blood testing from BioReference® can tell whether a patient is or was ever infected with HBV or HCV. We offer various panels that help determine whether a patient is positive for HBV or HCV infection, as well as tests to determine current liver health and to help manage treatment.

HCV Drug Resistance

For patients that have already been diagnosed with HCV, BioReference® offers a HCV NS3/NS5 a/b Panel to determine HCV drug resistance. The new HCV NS3 and NS5 a/b Panel will first determine if the viral load is >1000 IU/mL and the HCV genotype is type 1a, 1b or 1a/1b. If those conditions are met, the panel will then test for regions NS3, NS5a and NS5b simultaneously on a NGS platform. The variants that are detected will be reported and interpreted for HCV drug resistance. Please note this test is only available for non-New York patients.

FibroTest-ActiTest

Liver biopsy has been the standard procedure for diagnosis of chronic hepatitis and measurement of liver damage. BioReference® offers FibroTest-ActiTest, a non-invasive alternative that allows measurement of hepatitis progression using a simple blood sample.

• FibroTest analyzes five markers (alfa2-macroglobulin [g/l], apolipoproteinA1 [g/l], total bilirubin [micromoles/l], haptoglobin [g/l] and Gamma GT [IU/l]) and reports scores on a scale of 0 to 1, with correlating METAVIR classification.
• ActiTest measures liver activity by combining the FibroTest markers with alanine aminotransferase (ALT), and reports scores on a scale of 0 to 1, with correlating METAVIR classification.

Interpretation of Results

One of the most used histological classification scores for chronic HBV and HCV infections is the METAVIR system, which assesses fibrosis according to a five-stage classification and activity according to a four-grade classification. FibroTest-ActiTest proportionately measures the severity of the fibrosis and activity with a conversion to the METAVIR classification for ease of interpretation. Each report provides the FibroTest and ActiTest score, correlating METAVIR classification and results interpretation notes.

Test Benefits

While traditional liver biopsy is the gold standard for measuring fibrosis and activity, it is an invasive test with attendant risk of morbidity from bleeding, pneumothorax and peritonitis. FibroTest-ActiTest has the same diagnostic relevance as a 25mm liver biopsy, is easily reproduced and has the accuracy of a biochemical measurement (coefficient of variation < 5%).

Patient Considerations

• The reliability of results is dependent on compliance with the preanalytical and analytical conditions recommended by BioPredictive.
• The tests have to be deferred for acute hemolysis, acute hepatitis, inflammation and extra hepatic cholestasis.
• The advice of a specialist should be sought for interpretation in chronic hemolysis and Gilbert’s syndrome.
• The test interpretation is not validated in liver transplant patients.
• Isolated extreme values of one of the components should lead to caution in interpreting the results.
• In case of discordance between a biopsy result and FibroTest–ActiTest, it is recommended to seek the advice of a specialist. The causes of these discordances could be due to a flaw of the Test or to a flaw in the biopsy i.e., a liver biopsy has a 33% variability rate for one fibrosis stage.
• FibroTest is interpretable for both chronic HBV and HCV and alcoholic and non-alcoholic steatosis (NASH).
• ActiTest is interpretable for chronic HBV and HCV.