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Admission to treatment with DAAs in patients with chronic hepatitis C: are the actual criteria based on elastography correct?

Carlo Filice

Ultrasound Unit, Infectious Diseases Dept, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy

E-mail : carfil@unipv.it

DOI: 10.15761/GHE.1000116

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Dear Sir,

Elastonosonography currently plays an important role in the evaluation of hepatic fibrosis, and liver biopsy is used only in selected cases, given the diagnostic accuracy of the former compared to the latter as proven by an increasing number of papers in scientific journals, in the fields of internal medicine, gastroenterology, hepatology and infectious diseases.

The early works mainly documented the use of Transient Elastography (Fibroscan) in patients with HCV-related chronic liver disease, while more recently Real Time Elastosonography has been used in increasingly larger cohorts with often better results that those obtained with Fibroscan.

The cut –offs obtained using real time sonoelastography systems are different, however the accuracy of each histologic stage of liver fibrosis is very high.

As a result, Guidelines have been set up by scientific societies, both in the imaging and clinical fields [1-3].

Despite these  new developments, however, in several countries the agencies and governmental bodies in charge of controlling the use of Direct Antiretroviral Agents for the treatment of HCV related CLD, only accept the Fibroscan results (e.g. > 10 KPs), instead of those of liver biopsy, as a criterion to regulate  admission to treatment.

We believe that this criterion is outdated in the light of what said above about Real Time Elastography, and as such it should be modified as soon as possible.

Acknowledgment

Carlo Filice has served as a speaker for Esaote SpA, Philips Medical Systems and has received research grant from Bracco, Esaote, Hitachi-Aloka Medical Systems, Toshiba Medical Systems.

References

  1. Cosgrove D, Piscaglia F, Bamber J, Bojunga J, Correas JM, Gilja OH, et al. (2013) EFSUMB guidelines and recommendations on theclinical use of ultrasound elastography. Part 2: Clinical applications. Ultraschall Med 34: 238-253. [Crossref]
  2. Ferraioli G, Filice C, Castera L, Choi BI, Sporea I, Wilson SR, et al. (2015) WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 3: liver. Ultrasound Med Biol 41: 1161-1179. [Crossref]
  3. European Association for Study of Liver; Asociacion Latinoamericana para el Estudio del Higado (2015) EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis. J Hepatol 63: 237-264. [Crossref]

Editorial Information

Editor-in-Chief

Marcel C C Machado
Department of Clinical Emergencies,
University of São Paulo S2021 Copyright OAT. All rights reserv Brazil

Article Type

Letter to Editor

Publication history

Received date: May 02, 2016
Accepted date: June 07, 2016
Published date: June 10, 2016

Copyright

©2016 Filice C. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Citation

Filice C (2016) Admission to treatment with DAAs in patients with chronic hepatitis C: are the actual criteria based on elastography correct?. Gastroenterol Hepatol Endosc 1: doi: 10.15761/GHE.1000116

Corresponding author

Carlo Filice

Ultrasound Unit, Infectious Diseases Department, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy, Tel: +39 0382 502887

E-mail : carfil@unipv.it

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