APASL consensus statements and management algorithms for hepatitis C virus infection

2012 Hepatology International 6, 2 (409-435)

Assessment of liver fibrosis. Assessment of liver fibrosis is important clinically for decision making. Although liver biopsy remains the 'gold standard' to assess liver fibrosis, alternative noninvasive approaches to liver fibrosis have assumed great importance.
These include:
- Noninvasive imaging (e.g., transient elastography).
- Noninvasive blood marker panels (e.g., aspartate aminotransferase-platelet ratio index (APRI), FibroTest, FIBROSpect II, Hepascore, FibroMeter, and FibroFast).
Although noninvasive markers and transient elastography are useful for identifying only those patients with no fibrosis or with advanced fibrosis, a stepwise algorithm incorporating noninvasive markers and/or transient elastography may enhance the accuracy of diagnosis and reduce a significant number of liver biopsies. Furthermore, accumulating data provide evidence that noninvasive methods of assessing liver fibrosis can be applied at a single point or repeatedly to provide prognostically meaningful distinctions in predicting clinical outcomes, with and without antiviral therapy, in CHC patients. Algorithm incorporating noninvasive methods for clinical practice remains to be established.
Consensus statements: natural history of HCV infection. [...].
In patients with HCV-related liver cirrhosis, the risk of hepatic decompensation is approximately 3-4% per year and 1.4-6.9% per year for HCC. In chronic HCV infection, a surveillance program for the early detection of HCC should be offered. Invasive or noninvasive procedures may predict progression toward liver fibrosis and cirrhosis. Staging of fibrosis with transient elastography with or without liver biopsy may enable early prediction of HCC occurrence (II-2).
[...]Noninvasive procedures such as transient elastography and liver fibrosis markers, which are commercially available, may also provide important information about liver fibrosis and guide treatment.