title: Overestimate of Fibrosis by FIBROSpect® II in African Americans Complicates the Management of their Chronic Hepatitis C.
abstract: BACKGROUND
  Evaluation of advanced fibrosis in patients with hepatitis C virus (HCV) infection is used to facilitate decisions on treatment strategy and to initiate additional screening measures. Unfortunately, most studies have predominately Caucasian (Cau) patients and may not be as relevant for African Americans (AA).
  
  
  OBJECTIVE
  This study specifically addresses the issue of defining minimal vs. significant fibrosis in African Americans (AA) with chronic hepatitis C (CHC) using noninvasive assays.
  
  
  METHODS
  All patients (n = 319) seen between 1 January 2008 and 30 June 2013 for whom a FibroSpect II® (FSII) assay was performed and had data for calculation of aspartate aminotransferase (AST) platelet ratio index (APRI) and Fibrosis-4 (FIB-4) were identified using the medical records.
  
  
  RESULTS
  When liver biopsy score and FSII assay results for the AA patients with CHC were compared, 31% of AA had advanced FSII fibrosis scores (F2-F4) despite a biopsy score of F0-F1. In contrast, 10% of Cau over-scored. The AA false positive rate was 14% for APRI and 34% for FIB-4. Combining FSII with either APRI (7% false positive) or FIB-4 (10% false positive) improved the false positive rate in AA to 7% (FSII + APRI) and 10% (FSII + FIB-4) but reduced the sensitivity for significant fibrosis.
  
  
  CONCLUSIONS
  The FSII assay overestimates fibrosis in AA and should be used with caution since these patients may not have significant fibrosis. If the APRI or FIB-4 assay is combined with the FSII assay, minimal fibrosis in AA can be defined without subjecting the patients to a subsequent biopsy.
authors.affiliation: Wayne State University School of Medicine, Department of Internal Medicine, Division of Gastroenterology, Detroit, MI, USA.
authors.forename: Maher
authors.initials: M
authors.lastname: Tama
authors.affiliation: Wayne State University School of Medicine, Department of Internal Medicine, Division of Gastroenterology, Detroit, MI, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Naylor
authors.affiliation: Wayne State University School of Medicine, Department of Internal Medicine, Division of Gastroenterology, Detroit, MI, USA.
authors.forename: Suhag
authors.initials: S
authors.lastname: Patel
authors.affiliation: Wayne State University School of Medicine, Department of Internal Medicine, Division of Gastroenterology, Detroit, MI, USA.
authors.forename: Johnny
authors.initials: J
authors.lastname: Altawil
authors.affiliation: Wayne State University School of Medicine, Department of Internal Medicine, Division of Gastroenterology, Detroit, MI, USA.
authors.forename: Dhiraj
authors.initials: D
authors.lastname: Gulati
authors.affiliation: Wayne State University School of Medicine, Department of Internal Medicine, Division of Gastroenterology, Detroit, MI, USA.
authors.forename: Fadi
authors.initials: F
authors.lastname: Antaki
authors.affiliation: Wayne State University School of Medicine, Department of Internal Medicine, Division of Gastroenterology, Detroit, MI, USA.
authors.forename: Milton G
authors.initials: MG
authors.lastname: Mutchnick
authors.affiliation: Wayne State University School of Medicine, Department of Internal Medicine, Division of Gastroenterology, Detroit, MI, USA.
authors.forename: Murray
authors.initials: M
authors.lastname: Ehrinpreis
keywords: African Americans; Fibrosis; Fibrospect; Hepatitis c