[Assessment of liver fibrosis during Hepatitis C: liver needle-biopsy and non-invasive methods]

2007 Pratiques et organisation des soins 38, 4 (269-281)

In France, Hepatitis C affects more than 500,000 people, but only 50,000 people are being treated. The annual incidence is 5,000, and the disease becomes chronic in more than 80%of cases.The prognosis and therapeutic indications
depend on the quantification of the liver disease.The objective of this review is to compare the methods for assessing fibrosis.
Liver needle-biopsies, the reference method, require hospitalisation. This invasive examination is effective in diagnosing moderate fibrosis and any related lesions. Its main disadvantages are poor acceptance, the risk of complications,
variability, the discontinuous semi-quantitative estimation and the expense. Different scores combining serum fibrosis markers are proposed worldwide, given the inadequacy of individual markers. The most widespread, marketed on the internet, are French: Fibrotest® andActitest ®. For extreme values, in 50 % of cases, their performance is good. Their main advantages are that they are safe and low cost. Their main disadvantages are a lack of transparency in how the score is calculated, limited accessibility to member laboratories, and they are not covered by the social security system. Other scores exist: Fibrometre ®, Hépascore®, ELF score, etc.
Ultrasound impulse elastography (Fibroscan®), another non-invasivemethod with equivalent performances to biological scores, is not reimbursed by the French Health Insurance Scheme and is of restricted distribution.
In late 2006, the HauteAutorité de santé (French National Authority for Health) validated Fibrotest® and Fibroscan® as alternatives to liver biopsies in untreated chronic Hepatitis C without comorbidity.