Dr. Marcellin is a consultant for Hoffmann-La Roche, Gilead Sciences, GlaxoSmithKline, Bristol-Meyer-Squibb, Triangle Pharmaceuticals, Vertex, Bayer and Ortho Diagnostics and has received research grants from Hoffmann-LaRoche, Schering Plough Research Institute, and Bayer.
Fibrosis and disease progression in hepatitis C
Article first published online: 30 DEC 2003
Copyright © 2002 American Association for the Study of Liver Diseases
Supplement: Management of Hepatitis C: 2002
Volume 36, Issue Supplement 5B, pages s47–s56, November 2002
How to Cite
Marcellin, P., Asselah, T. and Boyer, N. (2002), Fibrosis and disease progression in hepatitis C. Hepatology, 36: s47–s56. doi: 10.1053/jhep.2002.36993
- Issue published online: 30 DEC 2003
- Article first published online: 30 DEC 2003
The progression of fibrosis in chronic hepatitis C determines the ultimate prognosis and thus the need and urgency of therapy. Fibrogenesis is a complex dynamic process, which is mediated by necroinflammation and activation of stellate cells. The liver biopsy remains the gold standard to assess fibrosis. Scoring systems allow a semiquantitative assessment and are useful for cross-sectional and cohort studies and in treatment trials. The rate at which fibrosis progresses varies markedly between patients. The major factors known to be associated with fibrosis progression are older age at infection, male gender, and excessive alcohol consumption. Viral load and genotype do not seem to influence significantly the progression rate. Progression of fibrosis is more rapid in immunocompromised patients. Hepatic steatosis, obesity, and diabetes may also contribute to more rapid progression of fibrosis. There are no tests that reliably predict the rate of progression of fibrosis in an individual patient. High serum alanine aminotransferase (ALT) levels are associated with a higher risk of fibrosis progression, and worsening of fibrosis is uncommon in patients with persistently normal serum aminotransferase levels. Serum markers for fibrosis are not reliable and need to be improved and validated. Liver biopsy provides the most accurate information on the stage of fibrosis and grade of necroinflammation, both of which have prognostic significance. Repeating the liver biopsy, 3 to 5 years after an initial biopsy is the most accurate means of assessing the progression of fibrosis.