Diagnostic evaluation of hepatitis C. Present aspects and personal experience

Some present aspects of hepatitis C clinical, virological and histological evaluation are briefly reviewed, with special regard to the relationships among different markers of chronic HCV infection and to their prognostic significance. Some data from our series of patients with chronic hepatitis C are also reported. Clinical diagnosis. In untreated chronic hepatitis C patients, high levels of ALT and GGT are usually associated with high values of the liver histological activity index. However, this correlation is weak and serum biochemical markers of hepatitis cannot be used, in the single patient, to predict the extent of liver histological damage. Low basal serum GGT level, on the other hand, seems to be, as shown also by us, a reliable predictor of response to IFN therapy. Standard liver ultrasonography and Doppler ultrasonography after glucagon injection can detect morphological and functional liver changes induced by chronic HCV infection, but their role in diagnostic evaluation of chronic hepatitis C is still limited. Virological diagnosis. Serum levels of HCV RNA are to some extent related to the degree of liver cell injury as reflected by serum ALT. In individual patients, however, we could not demonstrate any correlation between these two variables, probably because of spontaneous fluctuations of both of them. In any case, the largest amounts of serum HCV RNA are usually found in patients with long duration of HCV infection and/or histologically advanced chronic active hepatitis. Moreover, a low pretreatment HCV viraemia is generally regarded as one of the major independent predictors of both short-term and long-term response to IFN therapy. It is now established that chronic hepatitis due to type 1 HCV is usually associated with a liver disease more aggressive and more resistant to therapy than that caused by other viral genotypes. Also in our experience, patients with genotype lb infection showed the highest serum HCV concentrations and histological activity scores. In our opinion, quantitative assessment of viraemia and HCV genotyping could be included in the standard pretreatment evaluation of chronic hepatitis C patients. Histological assessment. Liver biopsy can be at present regarded as a useful and safe tool for the diagnostic evaluation of chronic hepatitis C. In our series, the efficacy and the absolute safety of ultrasound-guided liver biopsy were as high as 99.0% and 97,8%, respectively. By means of repeated liver biopsies, the quantitative assessment of liver necroinflammatory process (grading) and fibrosis (staging) can be used to monitor the natural course of chronic hepatitis C as well as its long-term response to IFN treatment.