Ladies/Gentlemen:
Could you please tell me how to interpret the Modified Hepatitis Activity Index
grading. What does a score of 0-18 means & its prognostic meaning? Also,
what is the current treatment for such severity of hepatitis B with a Mod.
Hepatitis Activity Index of 6/18 who is also slightly positive for Hepatitis C?
Thank you for your kind attention.
HT, M.D.
Dr. H T,
The Histologic Activity Index (HAI) was originally published by Dr. Knodell and
colleagues (Hepatology 1981;1:431) and is a scoring system that ranks the
amount of inflammation from 0 to 18 and fibrosis from 0 to 4. A modified HAI by
Ishak and colleagues ranks the amount of fibrous tissue on a scale of 0 to 6. Patients
with chronic hepatitis B and moderate inflammation, if they also have elevated
ALT levels, are potential candidates for antiviral therapy with any of the 3
approved regimens using interferon, lamivudine or adefovir. The latter two are
often preferred based on the absence of side effects. Your patient should be
worked up to see if chronic hepatitis C is present or not. If the anti-HCV test
is positive, and HCV RNA is also present, your patient is infected. If only the
anti-HCV is positive, your patient may have a false positive test or have
recovered from HCV infection. If your patient has HCV and HBV infection, they
is limited experience on the best treatment regimen, but most start with
treatment of the HCV infection first since the peginterferon will also be
active against HBV.
.