Assessment of hepatitis C: non-invasive fibrosis markers and/or liver biopsy

Chronic viral hepatitis is a prolonged inflammatory disease of the liver that may lead to the development of fibrosis, necro-inflammation and other associated pathological features. Because fibrosis and its end-point cirrhosis are the main causes of morbidity and mortality, fibrosis assessment is considered as the most relevant information for the evaluation of the severity of the disease and as a useful indicator for prognosis and treatment decision. Because fibrosis implies morphological damage, liver biopsy has come to be the natural gold standard for staging the disease. However, the high prevalence of chronic hepatitis C in addition to the cost and constraints generated by this procedure have triggered an intensive search for alternative methods for fibrosis evaluation. In this article, the strengths and weaknesses of liver biopsy and of non-invasive markers will be reviewed and their respective roles in management of patients with chronic hepatitis C will be discussed.