The impact of direct-acting antivirals on liver fibrosis in Egyptian hepatitis C virus patients: a single center experience

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Nadia Abdelaaty Abdelkader ◽  
Amira Mahmoud AlBalakosy ◽  
Ahmed Fouad Helmy Sherief ◽  
Mohamed Soliman Gado
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Liver Fibrosis ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Treatment Unit ◽  
Non Invasive ◽  
One Year ◽  
The Impact

Abstract Background Hepatitis C virus (HCV) infection affects approximately 170 million people worldwide, causing liver cirrhosis and hepatocellular carcinoma (HCC) and leading to liver transplantation and ultimately death. Accurate evaluation of liver fibrosis in patients with chronic liver diseases is crucial, as liver fibrosis is important in order to make therapeutic decisions, determine prognosis of liver disease and to follow-up disease progression. Multiple non-invasive methods have been used successfully in the prediction of fibrosis; however, early changes in noninvasive biomarkers of hepatic fibrosis under effective antiviral therapy are widely unknown. The aim of this study is to evaluate changes of transient elastography values as well as FIB-4 and AST to platelet ratio index (APRI) in patients treated with DAAs. Objectives The aim beyond this study is to evaluate the changes in liver stiffness in hepatitis C Egyptian patients before and at least one year after treatment with DAAs using transient elastography and non-invasive liver fibrosis indices as FIB-4 and APRI scores. Patients and methods The present study was conducted on 100 patients with chronic hepatitis C patients attended to Ain Shams University Hospitals, Viral hepatitis treatment unit between October 2017 and December 2018, who were followed-up during treatment and after treatment for at least one year (retrospective and prospective study). Total number of cases during the study period was 117 patients. 17 patients were excluded from the study due to missed follow-up. Eventually, 100 patients were enrolled in the study fulfilling the inclusion criteria. Results The mean age of our patients is 47.9 years with Male predominance (52 males and 48 females). There was a significant improvement of, platelets counts, ALT and AST levels, which in turn cause significant improvement in FIB-4 and APRI scores. There was a significant improvement of liver stiffness after end of treatment, regardless of the DAA regimen used, as evidenced by Fibroscan. Conclusion Fibrosis regression –assessed by non-invasive markers of fibrosis is achievable upon removal of the causative agent.

scholarly journals Evaluation of Liver Fibrosis by FibroScan in β-Thalassemia Children Infected with Hepatitis C Virus Before and After Ledipasvir/Sofosbuvir Therapy

2020 ◽  
pp. 9-17
Author(s):  
Aya Lotfy Yosef ◽  
Hanan Hamed Soliman ◽  
Gamal El-Sayed Shiha ◽  
Mohiee El-Deen AbdEl-Aziz Awad ◽  
Eslam El-Sayed El-Hawary
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Liver Fibrosis ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Hcv Infection ◽  
University Hospital ◽  
P Value ◽  
Non Invasive ◽  
Before And After

Background: Thalassemic children develop liver fibrosis because of liver iron overload and hepatitis C virus (HCV) infection. Transient elastography (FibroScan) can be a reliable non-invasive method for evaluating liver fibrosis in thalassemic patients. Treatment with ledipasvir/sofosbuvir (LED/SOF) direct acting antiviral agents can significantly affect liver stiffness measurement (LSM) by FibroScan. Aims: To assess liver fibrosis by non-invasive FibroScan through LSM before and after generic LED/SOF therapy in multi-transfused β-thalassemic children infected with HCV. Place and Duration of Study: Pediatric Hematology Unit, Tanta University Hospital, from November 2017 to May 2019. Methodology: Fifty multi-transfused β-thalassemic treatment-naϊve children (aged 12-18 years and weighing ≥35kg) with chronic HCV infection were subjected to clinical evaluation, quantitative HCV PCR assay, FibroScan examination, and calculation of APRI, FIB4 index and AST/ ALT ratio. In addition to standard therapy, generic LED/SOF (90/400 mg) treatment was given for 12 weeks’ duration with follow up for further 12 weeks after end of treatment. Results: A positive HCV PCR was changed into negative for all studied patients starting from week 4 after treatment. There was highly significant reduction in the LSM values by FibroScan in the studied patients after therapy (p-value <0.001) with median reduction of 19.4 %. The significant reduction in LSM values was particularly prominent in patients with significant (F2) and advanced (F3) liver fibrosis stages as well as cirrhotic patients (F4). There was significant reduction in the values of other non-invasive liver fibrosis markers FIB-4 index, APRI score and AST/ ALT ratio (p-value <0.001, <0.001 and 0.020 respectively) after therapy. Conclusion: Generic LED/SOF therapy for 12 weeks’ duration resulted in eradication of HCV infection that was associated with significant decrease in LSM by FibroScan particularly those with higher baseline liver fibrosis stages.

scholarly journals The applicability of non-invasive methods for assessing liver fibrosis in hemodialysis patients with chronic hepatitis C

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242601
Author(s):  
Jia-Jung Lee ◽  
Yu-Ju Wei ◽  
Ming-Yen Lin ◽  
Sheng-Wen Niu ◽  
Po-Yao Hsu ◽  
...  
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Liver Fibrosis ◽  
Diagnostic Accuracy ◽  
Chronic Hepatitis C ◽  
Transient Elastography ◽  
Hemodialysis Patients ◽  
Accurate Assessment ◽  
Non Invasive

Background The accurate assessment of liver fibrosis among hemodialysis patients with chronic hepatitis C (CHC) is important for both treatment and for follow up strategies. Applying the non-invasive methods in general population with viral hepatitis have been successful but the applicability of the aminotransferase/platelet ratio index (APRI) or the fibrosis-4 index (FIB-4) in hemodialysis patients need further evaluation. Materials and methods We conducted a prospective, multi-center, uremic cohort to verify the applicability of APRI and FIB-4 in identifying liver fibrosis by reference with the standard transient elastography (TE) measures. Results There were 116 CHC cases with valid TE were enrolled in our analysis. 46 cases (39.6%) were classified as F1, 35 cases (30.2%) as F2, 11 cases (9.5%) as F3, and 24 cases (20.7%) as F4, respectively. The traditional APRI and FIB-4 criteria did not correctly identify liver fibrosis. The optimal cut-off value of APRI was 0.28 and of FIB-4 was 1.91 to best excluding liver cirrhosis with AUC of 76% and 77%, respectively. The subgroup analysis showed that female CHC hemodialysis patients had better diagnostic accuracy with 74.1% by APRI. And CHC hemodialysis patients without hypertension had better diagnostic accuracy with 78.6% by FIB-4. Conclusions This study confirmed the traditional category level of APRI and FIB-4 were unable to identify liver fibrosis of CHC hemodialysis patients. With the adjusted cut-off value, APRI and FIB-4 still showed suboptimal diagnostic accuracy. Our results suggest the necessary of TE measures for liver fibrosis in the CHC uremic population.

Transient Elastography (Fibroscan®) In Adult Patients with Inherited Bleeding Disorders and Chronic Hepatitis C.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 1413-1413
Author(s):  
Maria Elisa Mancuso ◽  
Alessio Aghemo ◽  
Paolo Bucciarelli ◽  
Elena Santagostino ◽  
Mariagrazia Rumi ◽  
...  
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Liver Fibrosis ◽  
Success Rate ◽  
Predictive Value ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Bleeding Disorders ◽  
Non Invasive ◽  
Severe Fibrosis

Abstract Abstract 1413 Hepatitis virus C (HCV) infection is common in patients with inherited bleeding disorders due to the past use of plasma-derived clotting factor concentrates not treated with virucidal methods. The prognosis of the infection and the outcome of antiviral therapy are related to the stage of liver fibrosis. Since liver biopsy, the gold standard to grade fibrosis, is rarely performed in these patients for cost-benefit reasons, it is important to consider non invasive methods to assess fibrosis such as liver stiffness measurement with transient elastography (TE, Fibroscan®), a technique already validated in non hemophilic patients. We measured TE in 170 patients with inherited bleeding disorders and HCV infection (positive serum HCV-RNA). The main characteristics of these patients are reported in the Table. Steatosis was detected by abdominal ultrasound. Cirrhosis was defined by the presence of irregular liver edge, splenomegaly, dilated portal vein and/or esophageal varices combined either with low platelet count and/or reduced albumin/cholinesterase levels. TE was successfully performed in all but 3 patients, 2 of whom for Body Mass Index (BMI) > 30 kg/m2. Overall, the median value of liver stiffness was 7.2 kPa (interquartile range, IQR: 5.3–11.1) with a median success rate of 100% (IQR: 91–100) and a median IQR value of 1.0 (IQR: 0.7–1.9). HCV genotype or the presence of steatosis did not influence the TE values, whereas higher values were observed in patients with cirrhosis than in those without (median 19.8 kPa, IQR: 14.3–28.1 vs 6.8 kPa, IQR: 5.1–9.1, respectively; p< 0.01). In particular, 18/22 (82%) cirrhotic patients had a liver stiffness value ≥ 12.0 kPa, a cut-off previously identified as associated with severe fibrosis in HCV infected patients. Overall, splenomegaly was present in 51 patients (30%), 16 with cirrhosis and 35 without. In 31/35 (89%) of the latter, TE values were < 12 kPa. Moreover, among patients without cirrhosis, 12 (8%) had TE values ≥ 12 kPa: those patients had ALT and GGT levels significantly higher than patients with TE values < 12 kPa (p<0.05 for both variables). In our cohort TE had a 83% sensitivity, a 95% specificity and a 94% negative predictive value for the detection of severe fibrosis. In the same patients we measured the aspartate aminotransferase-to-platelet ratio index (APRI), a simple non-invasive biochemical marker of liver fibrosis. Median APRI values were significantly higher in patients with cirrhosis than in those without (1.6 vs 0.5, respectively; p<0.01), and a value > 1.5 was observed in 12/22 (55%) patients with cirrhosis. An APRI >1.5 had a 96% specificity and a 93% negative predictive value for the detection of severe fibrosis. Univariate and multivariate linear regression analyses were performed to investigate the relationship between log transformed TE and demographic (age, BMI) or laboratory (ALT, GGT, APRI) variables potentially influencing the TE values. By univariate analysis a linear association was found with age, ALT, GGT, APRI and BMI values (p<0.01 for each). In multivariate analysis APRI, ALT and GGT showed the strongest association with TE, while the statistical significance for BMI and age was marginal. The entire model explained about 50% of the variance of TE (R2= 0.49). Our results confirm that TE is a good tool to assess liver fibrosis also in patients with inherited bleeding disorders and chronic hepatitis C and shows that it can be performed safely in a great proportion of patients with a high success rate. The value of biochemical markers of necroinflammation (such as ALT and GGT) at the time of TE performance may influence the result and should be taken into account in the interpretation of the test. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Non-Invasive Indirect Markers of Liver Fibrosis after Interferon-Free Treatment for Hepatitis C

2021 ◽  
Vol 10 (17) ◽  
pp. 3951
Author(s):  
Dagmara Przekop ◽  
Jakub Klapaczynski ◽  
Agnieszka Grytczuk ◽  
Ewa Gruszewska ◽  
Andrzej Gietka ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Liver Fibrosis ◽  
Transient Elastography ◽  
Histopathological Examination ◽  
Hcv Rna ◽  
Significant Fibrosis ◽  
Non Invasive ◽  
Free Treatment ◽  
Ap Index

The effectiveness of interferon-free therapy during the course of HCV infection has already been confirmed. Liver fibrosis can be assessed in several ways, from biopsies to imaging tests. The present study evaluates the usefulness of non-invasive indirect biomarkers of liver fibrosis (APRI, GAPRI, FORNS, FIB-4, the AP index and HUI score) as markers of the effective treatment of HCV with the 3D regimen. Blood samples were collected from 70 patients suffering from chronic hepatitis C. Patients received the 3D AbbVie regimen for hepatitis C. All patients had HCV genotype 1b. The APRI, GAPRI, FIB-4, FORNS, HUI and AP index (age–platelet score) values were calculated with their respective algorithms. The stage of fibrosis was evaluated on the basis of a liver biopsy and confirmed by FibroScan-based transient elastography. An undetectable level of HCV RNA after 12 weeks of treatment with the 3D regimen indicates 100% eradication of hepatitis C virus. After the treatment, non-invasive indirect markers of liver fibrosis achieved levels below the limit for significant fibrosis, Thus, non-invasive indirect biomarkers of hepatic fibrosis failed to detect the presence of significant fibrosis, which was proved in histopathological examination. However, the eradication of hepatitis C virus by means of the 3D regimen treatment does not mean that patients were completely cured.

Non-invasive fibrosis assessment in chronic hepatitis C: aspartate-aminotransferase to platelet ratio index (APRI) and transient elastography (FibroScan)

2010 ◽  
Vol 151 (47) ◽  
pp. 1951-1955 ◽  
Author(s):  
Alajos Pár ◽  
Gabriella Pár
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Chronic Hepatitis C ◽  
Aspartate Aminotransferase ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Non Invasive ◽  
Apri Score

Bár a májbiopszia ma is „arany standard” a hepatológiai diagnosztikában, újabban a nem invazív próbák is egyre inkább előtérbe kerülnek a májfibrosis értékelésében. A szerzők az aszpartát-aminotranszferáz/thombocyta hányados (APRI) és a májtömöttség (elaszticitás) vizsgálatán alapuló tranziens elasztográfia szerepét tanulmányozták krónikus hepatitis C-vírus- (HCV-) infekcióban.Betegek és módszerek:Száztizenkilenc HCV-fertőzött beteg közül 75 szenvedett biopsziával igazolt krónikus C-hepatitisben, 24 HCV-cirrhosisban, 20 egyén tünetmentes, tartósan normális alanin-aminotranszferáz enzim értéket mutató HCV-hordozó volt, és 30 egészséges véradó szerepelt kontrollként. AWaiszerinti APRI-score kiszámítása az aszpartát-aminotranszferáz- és a thrombocytaszám-értékek alapján, a fibrosisra utaló májtömöttség (liver stiffness, LS) vizsgálata ultrahangalapú tranziens elasztográfiával, FibroScan alkalmazásával, míg a METAVIR fibrosisscore megállapítása májbiopszia révén történt.Eredmények:Krónikus C-hepatitisben mindkét fibrosismarker értékei szignifikánsan magasabbak voltak, mint a kontrollcsoportban, legmagasabb HCV-cirrhosisban. A tünetmentes HCV-hordozók adatai alig tértek el az egészségesekétől. Mindkét mutató értékei korreláltak a hisztológiai stádiumokkal. Az LS-vizsgálat érzékenyebb volt a fibrosis diagnosztizálásában, mint az APRI. A két fibrosismarker adatain alapuló szekvenciális algoritmus szerint a krónikus C-hepatitises betegek 47,8%-ában a szignifikáns (F≥2) fibrosis biopszia nélkül is feltételezhető.Következtetés:Az APRI-score és a tranziens elasztográfia, különösen kombinációban, hasznos nem invazív eljárás a fibrosis értékelésében krónikus HCV-infekcióban. Orv. Hetil., 2010,47,1951–1955.

scholarly journals High Kynurenine:Tryptophan Ratio Is Associated With Liver Fibrosis in HIV-Monoinfected and HIV/Hepatitis C Virus–Coinfected Women

2019 ◽  
Vol 6 (7) ◽  
Author(s):  
Ani Kardashian ◽  
Yifei Ma ◽  
Michael T Yin ◽  
Rebecca Scherzer ◽  
Olivia Nolan ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Liver Fibrosis ◽  
Transient Elastography ◽  
Multivariable Analysis ◽  
Liver Stiffness ◽  
Liver Stiffness Measurement ◽  
Tryptophan Catabolism ◽  
Hcv Coinfection ◽  
Relative Differences

Abstract Background Tryptophan catabolism, measured by the kynurenine:tryptophan (kyn/trp) ratio, is associated with gut microbiota alterations in people with HIV (PWH). We examined the association of the kyn/trp ratio with liver fibrosis in women with/without HIV infection. Methods The plasma kyn/trp ratio was measured in 137 HIV-monoinfected, HIV/hepatitis C virus (HCV)–coinfected, and uninfected women in the Women’s Interagency HIV Study. Fibrosis was estimated using FIB-4 in all participants and vibration-controlled transient elastography liver stiffness measurement (LSM) in a subset (n = 83). We used multivariable linear regression to evaluate the associations of infection status and kyn/trp ratio with relative differences in fibrosis estimates. Results The median kyn/trp ratio (interquartile range) was 0.056 (0.045–0.066) in HIV/HCV-coinfected, 0.038 (0.032–0.046) in HIV-monoinfected, and 0.031 (0.025–0.034) in uninfected women (P &lt; .001). After adjustment for sociodemographic, lifestyle, and metabolic factors, HIV monoinfection and HIV/HCV coinfection were associated with 37% (95% confidence interval [CI], 9% to 73%) and 164% (95% CI, 100% to 250%) greater FIB-4, respectively. When kyn/trp ratio was included, higher kyn/trp ratio was associated with greater FIB-4 (27% per kyn/trp doubling; 95% CI, 5% to 53%), and the associations of HIV monoinfection (29% per kyn/trp doubling; 95% CI, 2% to 63%) and HIV/HCV coinfection (123% per kyn/trp doubling; 95% CI, 63% to 203%) with greater FIB-4 were attenuated. Among those with LSM, higher kyn/trp ratio was associated with greater LSM (43% per kyn/trp doubling; 95% CI, 15% to 79%) in multivariable analysis. Conclusions The kyn/trp ratio is elevated in PWH and is associated with greater liver fibrosis. Tryptophan catabolism may modify the relationships between HIV, HCV, and fibrosis.

scholarly journals Two-Dimensional Shear Wave Elastography versus Transient Elastography: A Non-Invasive Comparison for the Assessment of Liver Fibrosis in Patients with Chronic Hepatitis C

Diagnostics ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. 313
Author(s):  
Rosanna Villani ◽  
Francesco Cavallone ◽  
Antonino Davide Romano ◽  
Francesco Bellanti ◽  
Gaetano Serviddio
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Liver Fibrosis ◽  
Shear Wave ◽  
Chronic Hepatitis C ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Shear Wave Elastography ◽  
Operating Characteristics ◽  
Non Invasive

In recent years, several non-invasive methods have been developed for staging liver fibrosis in patients with chronic hepatitis C. A 2D-Shear wave elastography (SWE) technique has been recently introduced on the EPIQ 7 US system (ElastQ), but its accuracy has not been validated in patients with chronic hepatitis C virus (HCV) infection. We enrolled 178 HCV patients to assess their liver fibrosis stage with ElastQ software using transient elastography as a reference standard. The best cut-off values to diagnose ≥ F2, ≥ F3, and F4 were 8.15, 10.31, and 12.65 KPa, respectively. Liver stiffness values had a positive correlation with transient elastography (r = 0.57; p < 0.001). The area under the receiver operating characteristics (AUROC) was 0.899 for ≥ F2 (moderate fibrosis), 0.900 for ≥ F3 (severe fibrosis), and 0.899 for cirrhosis. 2D-SWE has excellent accuracy in assessing liver fibrosis in patients with chronic hepatitis C and an excellent correlation with transient elastography.

Impact of Hepatitis C Virus Eradication Following Direct Acting Antivirals on Liver Stiffness Measurement

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Sameh Ghaly ◽  
Ahmed El-Ray ◽  
Laurent Castera ◽  
Ahmed M Al-Ashry
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Liver Fibrosis ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Genotype 4 ◽  
Before And After ◽  
Cirrhotic Patients ◽  
Research Institute Hospital ◽  
Research Institute

Abstract Background Hepatitis C infection is a disease with significant global impact, about 130150 million people chronically infected with the hepatitis C virus (HCV), representing about 2-2.5% of the world’s population. In Egypt, the prevalence is 10% and according to the last DHS in 2015 it was 7%. Aim of the Work to evaluate the effect of SVR using DAAs on the stage of the liver fibrosis in HCV patients by measuring of liver stiffness, using transient elastography before and after receiving treatment. Patients and Methods This study was conducted in co-operation between Gastroenterology and Hepatology Department, AinShams University and the Gastroenterology and Hepatology Department, Theodor Bilharz Research Institute between January 2019 to September 2019. It included 103 adult Egyptian patients who received SOF/DAC for three months and were assessed before and after achieving SVR-24. The patients were recruited from the outpatient clinic of Theodor Bilharz Research Institute Hospital (after consents were obtained). Results study showed that achieving SVR-24 was associated with improvement of LSM assessed by Transient Elastography and application of FIB-4 score and overall improvement of liver biochemistry as shown by reduction of AST, ALT and serum bilirubin and increase of serum albumin, INR and platelets. This was accompanied by increase of hemoglobin, Creatinine and BMI. The study also showed despite the fact that results were accompanied by significant improvement in LSM, Fib-4 and liver biochemistry, achieving SVR did not guarantee improvement of cirrhosis; only 29% of cirrhotics regressed to sub-cirrhotic range (LSM &lt;12.5 kPa). Conclusion Sofosbuvir / Daclatasvir combination is effective and well tolerated for treatment of genotype 4 chronic hepatitis C patients. Achieving SVR-24 was associated with significant improvement of LSM using transient elastography to assess liver fibrosis. Achieving SVR-24 was associated with overall improvement of liver biochemistry. Improvement of LSM was more in cirrhotic patients than non-cirrhotic patients.

scholarly journals The Importance of Transaminases Flare in Liver Elastography: Characterization of the Probability of Liver Fibrosis Overestimation by Hepatitis C Virus-Induced Cytolysis

2020 ◽  
Vol 8 (3) ◽  
pp. 348 ◽  
Author(s):  
Mauro Giuffrè ◽  
Sofia Fouraki ◽  
Manola Comar ◽  
Flora Masutti ◽  
Lory Saveria Crocè
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Liver Fibrosis ◽  
Eradication Therapy ◽  
Liver Stiffness ◽  
Hcv Infection ◽  
Logistic Regression Models ◽  
Liver Elastography ◽  
Serum Transaminases ◽  
The Impact

Background: Liver stiffness measurement (LSM) is crucial for appropriate fibrosis staging in patients with ongoing hepatitis C virus (HCV) infection. However, there is still an ongoing debate on the impact of serum transaminases (aspartate-aminotransferase, AST; alanine-aminotransferase, ALT) on LSM. Methods: We selected 110 patients undergoing HCV eradication therapy with LSM compatible with significant liver fibrosis. LSM was evaluated prior to therapy and one year after HCV eradication. Results: LSM showed a median decrease of 35% from baseline values, and 67 (61%) patients showed posttreatment values compatible with lower fibrosis stages. We developed two logistic regression models to determine the probability of liver fibrosis overestimation according to serum transaminase. The probability of overestimation of two or more fibrosis grade is equal to (1) 50% for AST of 99 IU/L (2.2 ULN) and ALT of 90.5 IU/L (2 ULN), (2) 80% for AST of 123.5 IU/L (2.74 ULN) and ALT of 101.5 IU/L (2.25 ULN), and (3) reaches 100% for AST of 211 IU/L (4.7 ULN) and ALT of 140 IU/L (3.1 ULN). Conclusions: This study highlights the impact of serum transaminases on LSM. We believe that our findings may serve as a reference point for appropriate fibrosis stratification by liver elastography in patients with HCV infection.

Sign in / Sign up

Export Citation Format

Share Document