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HEPATOLOGY, Vol. 36, No. 5, Suppl. 1, 2002

The progression of fibrosis is difficult to predict in the individual patient particularly based on assessment at one point in time. Serial serum ALT levels, grade of activity, and stage of fibrosis are the main predictors of progression of fibrosis. However, the overall predictive value of these characteristics is relatively weak and the progression of fibrosis is difficult to predict in the individual patient. The liver biopsy remains the best method to assess fibrosis and is valuable in determining prognosis and aiding in the decision for or against therapy. In untreated patients, reg- ular ALT measurements are useful, and repeat liver biopsy is the only reliable means of assessing the progression of fibrosis and is commonly recommended every 3 to 5 years in untreated patients. A second liver biopsy can distin- guish patients with rapidly progressive fibrosis, but may also merely indicate that the initial biopsy underestimated the degree of fibrosis. Overall, the risk of progression of fibrosis of more than 1 point in a 3- to 5-year period is low. In patients with factors associated with a higher risk of progression, such as age above 50 years, excessive alco- hol consumption, or high serum ALT levels, liver biopsy may be recommended more frequently (every 2 to 3 years); in contrast, in the younger patient with no other risk factor, the liver biopsies may be performed less fre- quently (every 5 to 10 years).

Future Research Needs

Prospective studies of the natural history of chronic hepatitis C would be helpful in defining the course of fibrosis in this disease, but are unlikely to be conducted in view of the rapidly evolving advances in therapy of this disease. However, prospective analyses of sequential liver biopsies from patients with mild chronic hepatitis C or who choose not to undergo therapy or who fail to respond to treatment are helpful. Most important in this regard would be the development and verification of accuracy of noninvasive measures of liver fibrosis. Serum fibrosis markers and combinations of several serum and blood tests to assess stage of hepatitis C need to be further re- fined and analyzed.


  • 1.

    Schuppan D, Ruehl M, Somasundaram R, Hahn EG. Matrix as a modu- lator of hepatic fibrogenesis. Semin Liver Dis 2001;21:351-372.

  • 2.

    Martinez Hernandez A, Amenta PS. Morphology, localization and origin of the hepatic extracellular matrix. In: Zern MA, Reid LM eds. Extracel- lular Matrix, Chemistry, Biology and Pathobiology With Emphasis on the Liver. New-York: Dekker, 1993:201-254.

  • 3.

    Lefkowitch JH, Schiff ER, Davis GL, Perillo RP, Lindsay K, Bodenheimer HC, Balart LA, et al. Pathological diagnosis of chronic hepatitis C. A multicenter comparative study with chronic hepatitis B. Gastroenterology 1993;104:595-603

  • 4.

    Scheuer PJ, Ashrafzadeh P, Sherlock S, Brown D, Dusheiko GM. The pathology of hepatitis C. HEPATOLOGY 1992;15:567-571.



    • 5.

      Goodman ZD, Ishak KG. Histopathology of hepatitis C virus infection. Semin Liver Dis 1995;15:70-81.

    • 6.

      Bedossa P. The cell origin of extracellulalr matrix proteins. J Hepatol 1993;19:1-3.

    • 7.

      Eng FJ, Friedman SL. Fibrogenesis I. New insights into hepatic stellate cell activation: the simple becomes complex. Am J Physiol 2000;279:G7-G11.

    • 8.

      Guido M, Rugge M, Chemello L, Leandro G, Fattovich G, Giustina G, Cassaro M, et al. Liver stellate cells in chronic viral hepatitis: the effect of interferon therapy. J Hepatol 1996;24:301-307.

    • 9.

      Bedossa P, Poynard T, Mathurin P, Lemaigre G, Chaput M. TGF-beta1 in situ expression in the liver of patients with chronic hepatitis C treated with alpha interferon. Gut 1993;34(Suppl 2):S146-S147.

  • 10.

    Paradis V, Mathurin P, Laurent A, Charlote F, Vidaud M, Poynard T, Hoang C, et al. Histological features predictive of liver fibrosis in chronic hepatitis C infection. J Clin Pathol 1996;49:1-7.

  • 11.

    Paradis V, Dargere D, Vidaud M, De Gouville AC, Huet S, Martinez V, Gauthier JM, et al. Expression of connective tissue growth factor in exper- imental rat and human liver fibrosis. HEPATOLOGY 1999;30:968-976.

  • 12.

    Knodell RG, Ishak KG, Black WC, Chen TS, Craig R, Kaplowitz N, Kiernan TW, et al. Formulation and application of a numeral scoring system for assessing histological activity in asymptomatic chronic active hepatitis. HEPATOLOGY 1981;1:431-435.

  • 13.

    Ishak K, Baptista A, Bianchi L, Callea F, De Groote J, Gudat F, Denk H, et al. Histologic grading and staging of chronic hepatitis. J Hepatol 1995; 22:696-699.

  • 14.

    Bedossa P, Poynard T. The METAVIR cooperative study group. An algo- rithm for the grading of activity in chronic hepatitis C. HEPATOLOGY 1996;24:289-293.

  • 15.

    Poynard T, Bedossa P, Opolon P for the OBSVIRC, METAVIR, CLINI- VIR, and DOSVIRC groups. Natural history of liver fibrosis progression in patients with chronic hepatitis C. Lancet 1997;349:825-832.

  • 16.

    Poynard T, Ratziu V, Charlotte F, Goodman Z, Mchutchison J, Albrecht

      • J.

        Rates and risk factors of liver fibrosis progression in patients with chronic hepatitis C. J Hepatol 2001;34:730-739.

  • 17.

    Marcellin P, Akre´mi R, Cazals D, Boyer N, Aupe´rin A, Vidaud D, Degott

      • C.

        Genotype 1 is associated with a slower progression of fibrosis in un- treated patients with mild chronic hepatitis C. J Hepatol 2001;34 (Suppl.

        • 1)

          :159. [abstract]

  • 18.

    Ghany MG, Kleiner DE, Alter HJ, Doo E, Khokhar F, Park Y, Liang TJ, et al. Progression of fibrosis in early stages of chronic hepatitis C. HEPA- TOLOGY 2000;32:496A.

  • 19.

    Alberti A, Boccato S, Ferrari A, Benvegnu L, Pontisso P, Noventa F, Gatta

      • A.

        Outcome of initially mild chronic hepatitis C [abstract]. HEPATOLOGY 2001;34:225A.

  • 20.

    Seeff LB, Buskell-Bales Z, Wright EC, Durako SJ, Alter HJ, Iber FL, Hollinger FB, et al. Long-term mortality after transfusion associated non-A non-B hepatitis. The National Heart, Lung and Blood Institute Study Group. N Engl J Med 1992;327:1906-1911.

  • 21.

    Alter HJ, Seeff LB. Recovery, persistence, and sequelae in hepatitis C virus infection: a perspective on long-term outcome. Semin Liver Dis 2000;20: 17-35.

  • 22.

    Tong MJ, El-Farra NS, Reijes AR, Co RL. Clinical outcomes after trans- fusion-associated hepatitis C. N Engl J Med 1995;332:1463-1466.

  • 23.

    Kenny-Walsh E. Clinical outcomes after hepatitis C infection from con- taminated anti-D immune globulin. N Engl J Med 1999;340:1228-1233.

  • 24.

    Wiese M, Berr F, Lafrenz M, Porst H, Oesen U. Low frequency of cirrhosis in a hepatitis C (genotype 1b) single-source outbreak in Germany: a 20- year multicenter study. HEPATOLOGY 2000;32:91-96.

  • 25.

    Freeman AJ, Dore GJ, Law MG, Thorpe M, Von Overbeck J, Lloyd AR, Marinos G, et al. Estimating progression to cirrhosis in chronic hepatitis C virus infection. HEPATOLOGY 2001;34:809-816.

  • 26.

    Wiley TE, McCarthy M, Breidi L, Mc Carthy M, Layden TJ. Impact of alcohol on the histological and clinical progression of hepatitis C infection. HEPATOLOGY 1998;28:805-809.

  • 27.

    Pessione F, Degos F, Marcellin P, Duchatelle V, Njapoum C, Martinot- Peignoux M, Degott C, et al. Effect of alcohol consumption on serum

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