[Noninvasive methods for predicting liver fibrosis in patients with chronic hepatitis C: alternatives to liver biopsy]

Abstract

Biochemical markers of liver fibrosis, because they can be tested noninvasively, reproducibly, and reliably, may constitute a true alternative to liver biopsies. Scores must be used only in the circumstances for which they have been validated. Scores for the Fibrotest-Actitest have been studied and validated most widely. Fibroscan, an imaging technique that uses transient elastrography to measures liver stiffness, has been validated acceptably for management of hepatitis C (HCV). General practitioners can order Fibroscan testing to assess the extent of hepatic lesions in patients with chronic HCV. Fibrotest and/or Fibroscan testing may replace liver biopsy in patients who can then receive first-or second-line treatment for HCV, regardless of genotype or transaminase levels. In the future, treatment decisions will probably rely on a combination (after validation) of these scores and on the development of genetic markers for fibrogenesis, to differentiate between patients highly likely and unlikely to develop serious fibrosis.