Page 36 - The Flying Publisher Guide to Hepatitis C Treatment

36 | Hepatitis C Treatment

Post-treatment LB is essential to demonstrate regression of
cirrhosis after viral supression. It is not recommended for
assessment of the efficacy of therapeutic regimens, unless
hepatic safety issues impose it.

Table 2.3 – Liver fibrosis evaluation methods*
Methods Categories Classification Comments
1) Invasive Liver biopsy Percutaneous Scoring systems are presented
Laparoscopic in Table 2.4
2) Non-invasive Serum Indirect markers Biomarker combinations or
biochemistry composite indexes
Direct markers Reflect extra cellular matrix
removal/deposition, the
balance between hepatic
fibrogenesis and fibrolysis, or
cytokines (TGF-β 1† and PDGF†)
associated with fibrosis
Imaging Elastography Fibroscan® is the most used
techniques Ultrasonography technique
CT, MRI, PET
Genetic Estimate the
markers transdifferentiation of hepatic
stellate cells to myofibroblasts
* According to data from Ahmad 2011.
† TGF-β1: transforming growth factors β1; PDGF: platelet derived growth factor
Different scoring systems (Table 2.4) have been defined in order
to classify the extent of necroinflammatory activity (grading)
and the extent of fibrosis (staging) in LB.
However, LB is invasive and has a number of drawbacks:
– substantial sampling error (extracts only 1/50,000 of the
liver)
– variability in interpretation
– potential serious adverse outcomes (bleeding)
– high cost (approximately $1000–$1500 per biopsy)
– low patient’s acceptability/reluctance to undergo repeated
biopsies