HCV Guidelines: Recommendations for Testing, Managing, and Treating Hepatitis C

2014

WHEN AND IN WHOM TO INITIATE HCV THERAPY
[...]Noninvasive tests to stage the degree of fibrosis in patients with chronic HCV infection include models incorporating indirect serum biomarkers (routine tests), direct serum biomarkers (components of the extracellular matrix produced by activated hepatic stellate cells), and vibration-controlled transient liver elastography. No single method is recognized to have high accuracy alone and each test must be interpreted carefully. [...]
Vibration-controlled transient liver elastography is a noninvasive way to measure liver stiffness and correlates well with measurement of substantial fibrosis or cirrhosis in patients with chronic HCV infection. A cutoff value of 8.7 kPa correlates with Metavir F2 or higher fibrosis stage; greater than 9.5 kPa with F3; and 14.5 or higher kPa with F4 or cirrhosis. The measurement range does overlap between stages. (Ziol, 2005)
The most efficient approach to fibrosis assessment is to combine direct biomarkers and vibration-controlled transient liver elastography. (Boursier, 2012) A biopsy should be considered for any patient who has discordant results between the 2 modalities that would affect clinical decision making. For example, 1 shows cirrhosis and the other does not. The need for liver biopsy with this approach is markedly reduced.