Longitudinal Evaluation of Hyaluronic Acid and Its Degrading Enzymes and Degradation Products in Egyptian Patients with Chronic Hepatitis C Treated By Pegylated Interferon and Ribavirin

Abstract—Background:

Pegylated interferon plus ribavirin are the most effective treatment for hepatitis C virus (HCV) till now. Liver biopsy is the gold standard of determining the staging of fibrosis but it had complications like pain, bleeding, and rarely death. So, this study was established to predict the usefulness of hyaluronic acid and its degrading enzymes and degradation products for prediction of fibrosis stage of these patients during and after treatment. And, to improve the anti-fibrotic effect of IFN therapy. Materials and Methods: This follow up study was carried out on 52 HCV patients treated with PEG-IFN/ribavirin for 48 weeks and followed for 6 months after treatment. Liver biopsy was done before treatment. The diagnostic accuracy of hyaluronic acid (HA), β- glucuronidase, N-acetyl-β-D-glucosasminidase (NAG), hyaluronidase activities, glucosamine, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) was elevated. Results: the levels of HA was increased with the severity of fibrosis and decreased after treatment even in non-responders, sustained virological response (SVR) and relapsers patients. HA and β-glucronidase were considered the best markers for discriminating F3 versus F1/F2 with AUCs 0.981 and 0.647, respectively. Serum hyaluronidase activity is the best parameter for distinguish responder from non-responder with a cut-off 84.2 mg NAG/ml/18hr. The serum activity of β-glucurinidase was increased than its value at the start of treatment. Also, the mean activities of AST and AST in sera of responders groups were very significantly decreased with IFN treatment. While, the mean serum NAG activities were significantly decreased at the start of treatment then no significance variation was observed until the end of treatment (ETR). There was no significant variation in the serum levels of glucosamine during the treatment period of responder patients, but there was an extremely significant increase in the end of treatment (ETR).