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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.

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