With improvements in the outcome of treatment of HCV, however, many experts now question the need for liver biopsy. In the Consensus Conference of the National Institutes of Health held in 2002, it was concluded that liver biopsy, although not mandatory, should still be performed in patients with HCV infection. The rationale of this decision is that patients with moderate to severe hepatitis on liver biopsy are likely to develop cirrhosis and therefore warrant immediate treatment, while treatment can be postponed for milder cases until more effective and tolerable options become available.
Pretreatment biopsy can help determine the prognosis after treatment. Although noninvasive laboratory markers can provide a crude estimate of the severity of inflammation and the extent of fibrosis, they are far less accurate than liver biopsy. In a systematic review of the literature, Gebo et al reported that advanced fibrosis or cirrhosis on initial biopsy is associated with a modestly decreased likelihood of a sustained virolog-ical response to treatment. Biochemical and serological tests were best at identifying patients with no or minimal fibrosis, or those with advanced fibrosis/cirrhosis, but who were poor at grading intermediate levels of fibrosis. On the other hand, liver biopsy is useful at predicting the efficacy of treatment. This is particularly true for patients with coexisting steatosis or alcohol abuse, as both conditions have been shown to hasten the development of fibrosis. Take advantage of this opportunity – to enjoy lowest prices online.