Diagnosis and monitoring of liver fibrosis in patients with chronic hepatitis C

Hepatic fibrosis caused by chronic hepatitis C may gradually cause cirrhosis, liver failure, and hepatocellular carcinoma (HCC). It was reported that, of those with chronic hepatitis C, 15% to 25% will develop progressive liver disease, end stage liver disease, hepatocellular carcinoma or will require liver transplant. Therefore, the diagnosis and monitoring of liver fibrosis is essential in the management of patients with chronic hepatitis C. Liver biopsy has traditionally been considered the gold standard for the evaluation of hepatic fibrosis and is used as a benchmark for initiating treatment. The limitations of liver biopsy include the fact that it is an invasive procedure, observer variability, sampling error and lack of suitability for longitudinal monitoring. More important, it is associated with rare but potentially life-threatening complications. These limitations of liver biopsy have led to the development of non-invasive methods. Currently available tests rely on two different but complementary approaches: a 'biological' approach based on serum biomarkers of fibrosis and a 'physical imaging' approach based on the measurement of liver stiffness using transient elastography. The aim of this review is to evaluate the evidence regarding the validity of non-invasive methods and their cost effectiveness compared with liver biopsy in the diagnosis and monitoring of liver fibrosis in patients with chronic hepatitis C viral infection.