VALUE OF LIVER-BIOPSY PRIOR TO INTERFERON THERAPY FOR CHRONIC VIRAL-HEPATITIS

The present study prospectively evaluated the value of liver biopsy in patients with chronic hepatitis B (N = 75) and C (N = 135) prior to i nterferon therapy. Biopsy specimens revealed cirrhosis in 26% of patie nts with hepatitis B and 30% with hepatitis C. Although cirrhosis was not predictable by laboratory values in individual patients mean gamma -GT, alkaline phosphatase, and bilirubin levels were significantly hig her in patients with cirrhosis compared to those without. Since cirrho sis significantly impairs the response rate to interferon therapy in h epatitis C but not in hepatitis B, liver biopsy is important for the m anagement of chronic hepatitis C infection. In 88% of patients with se rum HBV-DNA, irrespective of the serum HBeAg status, chronic active he patitis was seen. Similarly, chronic active hepatitis was found in 84% of patients with elevated aminotransferases and hepatitis C antibodie s. Thus, chronic active hepatitis was diagnosed in the majority of cas es with chronic viral hepatitis, showing that this histopathological d iagnosis is of little additional value for the recommendation on inter feron treatment in these patients. However, none of the other grading systems of liver biopsy specimens described so far have been evaluated for their ability to predict overall prognosis or response rates to i nterferon therapy. Therefore, the physician is presently left with the questionable value of a procedure with well-known risks and costs in patients suitable for interferon treatment. Hence, prospective randomi zed controlled studies to evaluate histopathological grading systems a re urgently needed to redefine the necessity of liver biopsy in this r outine clinical setting.