Abstract
The correlation between HCV genotypes and possible serum markers for clinical prediction of disease progression is still controversial. The diagnostic accuracy of serum markers (alpha-fetoprotein (AFP), tumor necrosis factor- alpha (TNF-alpha), and hyaluronic acid (HA) in assessment of hepatic fibrosis was evaluated in 130 treatment-naive CHC patients who had undergone liver biopsy. 70 healthy subjects were used as reference control. Patients who had laboratory test results of (AST, ALT AFP, TNF-alpha, HA) allowing the calculation of HA-to platelet ratio (HAPRI), AFP-to platelet ratio (AFPPRI) and TNF-to platelet ratio (TNFPRI) were included in this study. Serum HCV RNA positive patients were chosen for HCV genotype analysis using line probe assay. The degree of fibrosis scored according to the METAVIR staging system. ROC (receiver operating characteristics) curves of serum markers were used to predict liver fibrosis. In patients with HCV genotype 4 (n =56; 43.1), there was a significant increase (p<0.001) in the levels of serum markers and liver fibrosis, whereas, ninety (69.2 %) patients had significant fibrosis (F2-F4) and fifty four (41.5%) had cirrhosis (F4). Using diagnostic cut-off values of serum markers (HA, AFP, and TNF), significant fibrosis and cirrhosis could be correctly predicted in 74.6%, 73.1%, 75.3% for fibrosis and 83.1%, 61.5%, 43.85% for cirrhosis respectively. The data showed that HA, AFP, and TNF can accurately detect fibrosis in patients with different HCV genotypes and may use as non-invasive biomarkers in predicting severity of liver disease in patients with varying HCV genotype.