[Indications by the Italian Association for the Study of the Liver (AISF) on the use of triple therapy (pegylated alfa interferon + ribavirin + first-generation protease inhibitor) for the treatment of HCV genotype 1 patients]


Appendix 1 Evaluation and estimation of the extent of fibrosis
The determination of the stage of fibrosis should preferentially be based on histological examination. [...]
Based upon the available literature on the subject, the guidelines of the European Association for the Study of the Liver (EASL) support, in the absence of histological examination, the use of alternative non-invasive techniques. Among these techniques, it is recommended, for the diffusion of technical and clinical experience now confirmed in many Italian hepatological centers, the use of liver elastography by means of the Fibroscan. It is noted, that at this date, there is no uniformity in consensus on the numerical cut-off for the determination of mild fibrosis corresponding to F > 2 on Metavir or Ishak scales. This is due to numerous causes: intrinsic variability of the technique, influence of the necro-inflammatory and corresponding liver damage on stiffness measurement, and variability of the populations enrolled in the studies published in the literature. In 2010, AISF has promoted and coordinated a working group composed of Italian experts (called ELASTICA). The experts, in a consensus document, outlined the criteria to ensure that the technical requirements for the execution and reporting of the examination and defined as the levels of Fibroscan 8.7 kPa are strongly suggestive of clinically significant fibrosis (expert consensus).