hepatitis C virus (HCV) infection continues to be a major burden on the world. Approximately 80% of patients with hepatitis C virus develop chronic infection, and progression to cirrhosis occurs in approximately 20% of these subjects. Liver biopsies are considered to be the 'gold standard' to determine the degree of liver injury in chronic hepatitis C virus infection. Because of the hazards associated with performing liver biopsy, it is beneficial to search for a more save approach for evaluating the extent of hepatic injury.
Objectives: the aim of this study is to evaluate the correlations between HCV RNA titers and extent of hepatic histopathologic injury and whether HCV RNA titers can replace liver biopsies in assessing the severity of such histopathologic injury.
Patients and methods: this study included 400 chronic HCV-infected adult patients, 226 males and 174 females, with ages ranged from 27 to 62 years; patients with co-existing liver diseases that could change the degree of hepatic histopathologic injury were excluded. For each patient, complete history taking and thorough physical examination were done; the following investigations were performed: serum HCV antibodies, serum liver enzymes (ALT, AST, alkaline phosphatase, and GGT), serum bilirubin, plasma albumin, PT, HCV RNA titer, histological examination of liver biopsy, abdominal ultrasonography and specific investigations to exclude the coexisting liver diseases.
Results: insignificant differences of mean HCV RNA titers among patients with various grading scores of necroinflammatory reactions (F test = 7.13 & P value = 0.053) as well as among patients with various staging scores of fibrosis ( F test = 3.91 & P value = 0.147) were revealed. Also, on studying males and females separately, statistically insignificant differences of mean HCV RNA levels were observed among male patients as well as female patients with various histopathologic scores. Regarding patients' ages, a statistically significant correlations could be observed among HCV RNA levels and various grading scores of necroinflammatory reactions as well as various staging scores of fibrosis in patients aged more than 40 years, but these correlations were not linear.
Conclusion: the degree of HCV RNA titers cannot predict the extent and severity of hepatic histopathologic injury in chronic HCV-infected patients. Therefore, estimating HCV RNA levels cannot replace liver biopsies in determining such histopathologic changes.
Recommendations: further studies are recommended to evaluate the correlations between hepatic histopathologic injury and hepatic enzymes as well as some inflammatory cytokines (TNF-α, Il-10, TGF-β) in an attempt to search for a non-invasive more save predictor of such histopathologic injury.
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