23. Natural History of Chronic HCV Infection and Non-Invasive Assessment of Hepatic Fibrosis

  1. Howard C. Thomas BSc, PhD, FRCP, FRCPath, FMedSci2,
  2. Anna S.F. Lok MD3,
  3. Stephen A. Locarnini MBBS, BSc(Hons), PhD, FRCPath4 and
  4. Arie J. Zuckerman MD, DSc, FRCP, FRCPath, FMedSci5
  1. Laurent Castera

Published Online: 26 JUL 2013

DOI: 10.1002/9781118637272.ch23

Viral Hepatitis, Fourth Edition

Viral Hepatitis, Fourth Edition

How to Cite

Castera, L. (2013) Natural History of Chronic HCV Infection and Non-Invasive Assessment of Hepatic Fibrosis, in Viral Hepatitis, Fourth Edition (eds H. C. Thomas, A. S.F. Lok, S. A. Locarnini and A. J. Zuckerman), John Wiley & Sons, Ltd, Oxford, UK. doi: 10.1002/9781118637272.ch23

Editor Information

  1. 2

    Emeritus Professor of Hepatology, Department of Medicine, Imperial College London, London, UK

  2. 3

    Alice Lohrman Andrews Research Professor in Hepatology, Director of Clinical Hepatology, Professor of Internal Medicine, Associate Chair for Clinical Research, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA

  3. 4

    Head, Research & Molecular Development, Victorian Infectious Diseases Reference Laboratory, Melbourne, VIC, Australia

  4. 5

    Emeritus Professor of Medical Microbiology, Formerly Principal and Dean, Royal Free Hospital School of Medicine

Author Information

  1. Service d’Hépatologie, Université Denis Diderot Paris-VII, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France

Publication History

  1. Published Online: 26 JUL 2013

ISBN Information

Print ISBN: 9780470672952

Online ISBN: 9781118637272



  • liver fibrosis;
  • liver biopsy;
  • non-invasive;
  • serum biomarkers;
  • liver stiffness;
  • transient elastography;
  • fibroscan


The natural history of hepatitis C is highly variable from one infected individual to another. Once chronic infection is established, prognosis mainly depends on the amount and progression of liver fibrosis and the risk of developing cirrhosis. Liver biopsy, traditionally considered as the reference standard for staging of fibrosis, has been challenged over the past decade by the development of novel non-invasive methodologies. These methods rely on two distinct but complementary approaches: (1) a “biological” approach based on the levels of serum biomarkers of fibrosis, and (2) a “physical” approach based on the measurement of liver stiffness using transient elastography. The use of non-invasive methods to assess liver fibrosis in chronic hepatitis C has resulted in a significant decrease in the need for liver biopsy. However, these methods will likely not completely abolish the need for liver biopsy, and they should rather be employed as an integrated diagnostic algorithm with liver biopsy.