Role of assessing liver fibrosis in management of chronic hepatitis C virus infection.
Fibrosis progression is common in hepatitis C. Both host and viral factors influence its natural history. Liver fibrosis is a key predictive factor for advanced disease including endpoints such as liver failure, cirrhosis and hepatocellular carcinoma (HCC). METAVIR fibrosis stages F3-F4 have been considered as the threshold for antiviral therapy. However, this aspect is controversial after the advent of new direct-acting antivirals (DAAs) because they show an excellent efficacy and safety profile. Moreover, in the DAA era, fibrosis stage seems not to be a predictive factor of a sustained virological response (SVR). Viral eradication decreases liver damage by improving the inflammation, as well as by regressing fibrosis irrespective of the treatment regimen. Non-invasive methods are useful in the assessment of liver fibrosis, replacing liver biopsy in clinical practice; but their usefulness for monitoring fibrosis after SVR needs to be demonstrated. Fibrosis regression has been demonstrated after the eradication of hepatitis C virus infection and is associated with a lower risk of hepatic cirrhosis and liver cancer. However, patients showing advanced fibrosis and cirrhosis must be followed-up after SVR, as risks of portal hypertension and HCC remain.
Inter-Centre Unit of Digestive Diseases and CIBERehd, Virgen del Rocio-Virgen Macarena University Hospitals, Sevilla, Spain.
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Carmona
Inter-Centre Unit of Digestive Diseases and CIBERehd, Virgen del Rocio-Virgen Macarena University Hospitals, Sevilla, Spain.
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Cordero
Inter-Centre Unit of Digestive Diseases and CIBERehd, Virgen del Rocio-Virgen Macarena University Hospitals, Sevilla, Spain; Institute of Biomedicine of Seville, Sevilla, Spain.
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Ampuero
Inter-Centre Unit of Digestive Diseases and CIBERehd, Virgen del Rocio-Virgen Macarena University Hospitals, Sevilla, Spain; Institute of Biomedicine of Seville, Sevilla, Spain.
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Rojas
Inter-Centre Unit of Digestive Diseases and CIBERehd, Virgen del Rocio-Virgen Macarena University Hospitals, Sevilla, Spain; Institute of Biomedicine of Seville, Sevilla, Spain. Electronic address: mromerogomez@us.es.
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Romero-Gómez
D000998:Antiviral Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D019468:Disease Management; D018450:Disease Progression; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008103:Liver Cirrhosis / Q000473:pathology*; D000072230:Sustained Virologic Response
D000998:Antiviral Agents
Direct-acting antiviral; Hepatitis C; Liver biopsy; Non-invasive markers; Pegylated interferon