By: Marcus J. Hopkins, Blogger
As our understanding of the Hepatitis C Virus (HCV) increases, we learn more about how the virus affects our bodies and well as develop better diagnostic and treatment tools to screen for and mitigate the comorbidities that arise from untreated HCV. New technologies can be used to test liver fibrosis without invasive biopsy tools – which remain the most effective way to measure liver damage and scarring (fibrosis) – with a high degree of accuracy…under certain conditions. Additionally, further research has indicated that, in addition to the deleterious effects of HCV on the liver, when left untreated, HCV can result in Chronic Kidney Disease (CKD).
Virtual Touch™ Quantification (VTQ – Siemens) is a noninvasive diagnostic procedure that allows patients to undergo various types of tissue analyses without the need for surgery or biopsies using Acoustic Radiation Force Impulse (ARFI) – a sonographic technique that determines the local mechanical properties of tissue (a fancy way of saying “stiffness”). Essentially, much like an ultrasound during pregnancy, ARFI and VTQ uses a conventional ultrasound probe during abdominal ultrasonography to measure the stiffness of the liver. This is especially effective in patients with ascites – an accumulation of protein-containing (ascitic) fluid within the abdomen – an advancement over the Fibroscan (Transient Elastography – Echosens) which cannot (Bennett, 2018).
The research (Tsukano, et al., 2017) also indicates that skin liver capsule distance (SCD) – the distance between the skin and the liver capsule – corresponded highly with any discrepancies between VTQ and liver biopsy analyses. Patients with a long SCD may receive less accurate results using VTQ. Steatosis, hepatic inflammation, and hepatocyte ballooning have little effect on ARFI measurement failures (Bennett).
Another study (Park, et al., 2017) discovered that patients with HCV are at higher risk of developing CKD. The research found that Chronic HCV is associated with extrahepatic manifestations – problems that occur outside the liver, some of which are associated with the immune system, and others seem to be driven by chronic inflammation – with CKD being the most commonly reported extrahepatic condition. Untreated Chronic HCV leads to a 27% increase for developing CKD, while treating the disease using Interferon-based dual, triple, and all-oral Direct Acting Antivirals (DAAs) had a 30% reduction in risk for developing CKD. The researchers indicated that they were “disturbed” to find that 79% of patients with Chronic HCV did not receive treatment (van Paridon, 2018). The increased risk of CKD was more significant in patients age 18-49, compared to adults aged 60≥.
While more research is needed, this should serve as a caution to payors and legislators who have been reluctant to approve treatment methods for HCV patients due to associated short-term expenditures.
- Bennett, T. (2018, January 03). Virtual touch quantification accurately measures fibrosis stage. Thorofare, NJ: Healio [dot] com: Hepatology. Retrieved from: https://www.healio.com/hepatology/steatohepatitis-metabolic-liver-disease/news/online/%7B2ac66538-1e34-4064-9a6f-d54edd7519a1%7D/virtual-touch-quantification-accurately-measures-fibrosis-stage
- Park, H., Chen, C., Wang, W., Henry, L., Cook, R. L. and Nelson, D. R. (2017, December 23). Chronic hepatitis C virus (HCV) increases the risk of chronic kidney disease (CKD) while effective HCV treatment decreases the incidence of CKD. Hepatology. doi: 10.1002/hep.29505
- Tsukano, N., Miyase, S., Saeki, T., Mizobe, K., Iwashita, H., Arima, N., and Fujiyama, S. (2017, December 11). The usefulness of Virtual Touch Quantification for staging liver fibrosis in patients with hepatitis C, and the factors affecting liver stiffness measurement failure compared with liver biopsy. Hepatol Res. doi: 10.1111/hepr.13041
- van Paridon, B. (2018, January 03). Greater Risk for Chronic Kidney Disease in Untreated HCV. New York, NY: Infectious Disease Advisor: Hepatitis Advisor. Retrieved from: http://www.infectiousdiseaseadvisor.com/hepatitis-advisor/hcv-risk-chronic-kidney-disease/article/734608/
Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.