EASL Recommendations on Treatment of Hepatitis C 2015

2015 Journal of Hepatology 63, 1 (199-236)

Pre-therapeutic assessment Liver biopsy has been for many years the reference method for grading the activity and histological progression (staging) of the disease. In chronic hepatitis C, considerable evidence suggest that non-invasive methods can now be used instead of liver biopsy to assess liver disease severity prior to therapy at a safe level of predictability. Liver stiffness measurement can be used to assess liver fibrosis in patients with chronic hepatitis C, provided that consideration is given to factors that may adversely affect its performance such as obesity. Well-established panels of biomarkers of fibrosis can also be applied. Both liver stiffness measurement and biomarkers perform well in the identification of cirrhosis or no fibrosis, but they perform less well in resolving intermediate degrees of fibrosis. The combination of blood biomarkers or the combination of liver stiffness measurement and a blood test improve accuracy and reduce the need for liver biopsy to resolve uncertainty. These tests are of particular interest in patients with coagulation disorders, though transjugular liver biopsy may also be used safely in this situation with the bonus that portal pressure can also be assessed. In case of contradictory results with noninvasive markers, liver biopsy may be indicated. Also, histology may be required in cases of known or suspected mixed aetiologies (e.g. HCV infection with HBV infection, metabolic syndrome, alcoholism or autoimmunity).
Recommendations Fibrosis stage can be assessed by non-invasive methods initially, with liver biopsy reserved for cases where there is uncertainty or potential additional aetiologies (A1). Bleeding disorders Progression to end-stage liver disease in patients with haemophilia is similar to HCV-positive individuals in the general population. The investigation of chronic liver disease in haemophilia is the same as in non-haemophilic individuals. Transjugular liver biopsies have enhanced the safety of the procedure. Non-invasive methods can be utilised to monitor disease progression. Follow-up of untreated patients and of patients with treatment failure Untreated patients with chronic hepatitis C and those who failed to respond to previous treatment should be regularly followed. The reason(s) for non-treatment and treatment failure should be clearly documented. Untreated patients should be assessed every 1 to 2 years with a non-invasive method.
Recommendations Non-invasive methods for staging fibrosis are best suited for follow-up assessment at intervals (A1).

Pubmed : 25911336