Fibrosis in patients with chronic hepatitis C: Detection and significance

Estimates of the extent of hepatic fibrosis and the rate of fibrosis progre ssion represent important surrogate end points for evaluation of the vulner ability of an individual patient and for assessment of the impact of treatm ent on natural history in chronic hepatitis C. Using the median fibrosis pr ogression rate, the median expected time to cirrhosis in untreated patients is around 30 years. However one third of patients have an expected median time to cirrhosis of less than 20 years and one third will only progress to cirrhosis in more than 50 years, if ever. Factors independently associated with fibrosis progression are duration of infection, age, male gender; con sumption of alcohol human immunodeficiency virus co-infection, and low CD4 count, Evaluation of fibrosis progression is useful to decide treatment. Am ong patients with sustained viral response, fibrosis regresses. Evaluation of fibrosis progression has permitted validation of the concept of suppress ive therapy. Among patients without viral clearance, interferon alone or in combination wish ribavirin significantly reduces fibrosis progression rate in comparison with progression before treatment and to control groups. The re is a major need for noninvasive markers of liver fibrosis, None are clea rly useful today for the diagnosis of early stages of fibrosis.