Published online Aug 28, 2014. doi: 10.3748/wjg.v20.i32.11033
Revised: April 14, 2014
Accepted: June 13, 2014
Published online: August 28, 2014
Chronic infection with hepatitis C virus (HCV) is a leading cause of liver-related morbidity and mortality worldwide and predisposes to liver fibrosis and end-stage liver complications. Liver fibrosis is the excessive accumulation of extracellular matrix proteins, including collagen, and is considered as a wound healing response to chronic liver injury. Its staging is critical for the management and prognosis of chronic hepatitis C (CHC) patients, whose number is expected to rise over the next decades, posing a major health care challenge. This review provides a brief update on HCV epidemiology, summarizes basic mechanistic concepts of HCV-dependent liver fibrogenesis, and discusses methods for assessment of liver fibrosis that are routinely used in clinical practice. Liver biopsy was until recently considered as the gold standard to diagnose and stage liver fibrosis. However, its invasiveness and drawbacks led to the development of non-invasive methods, which include serum biomarkers, transient elastography and combination algorithms. Clinical studies with CHC patients demonstrated that non-invasive methods are in most cases accurate for diagnosis and for monitoring liver disease complications. Moreover, they have a high prognostic value and are cost-effective. Non-invasive methods for assessment of liver fibrosis are gradually being incorporated into new guidelines and are becoming standard of care, which significantly reduces the need for liver biopsy.
Core tip: Chronic hepatitis C is a leading cause of liver-related morbidity and mortality and predisposes to liver fibrosis, the excessive accumulation of extracellular matrix proteins. The staging of liver fibrosis is critical for the management and prognosis of patients. This review provides an update on hepatitis C virus (HCV) epidemiology, summarizes basic mechanisms of HCV-dependent liver fibrogenesis, and discusses common methods for assessment of liver fibrosis. While liver biopsy was until recently considered as the gold standard, novel non-invasive methods, including serum biomarkers, transient elastography and combination algorithms, are gradually being incorporated into new guidelines and are becoming standard of care.