Chronic viral hepatitis: liver biopsy, yes or no?

• Published in: Revista española de enfermedades digestivas Vol. 94; no. 10; pp. 613 - 624
• Main Author: Castellano Tortajada, G
• Format: Journal Article
• Language: English; Spanish
• Published: Spain 01.10.2002
• Subjects: Biopsy - economics; Chronic Disease; Cost-Benefit Analysis; Hepatitis, Viral, Human - complications; Hepatitis, Viral, Human - economics; Hepatitis, Viral, Human - epidemiology; Hepatitis, Viral, Human - pathology; Hepatitis, Viral, Human - therapy; HIV Infections - complications; Humans; Liver - pathology; Prognosis
• ISSN: 1130-0108

LB increases costs and has--although minimal--potential risks; however, LB is: a) the gold standard to get to know lesion severity (grade and stage); b) the only method for the diagnosis of an F3 stage, which progresses to liver cirrhosis in approximately 10 years; c) the only method for the certain diagnosis of compensated liver cirrhosis, which requires early diagnosis programs for oesophageal varices and hepatocarcinoma; and d) the only method for the certain diagnosis of lesions predicting a good therapeutic response. On all these grounds--save for exceptions (contraindications, clinical and/or ultrasonographic cirrhosis)--liver biopsy should be carried out in the initial study of all patients. In non-responders to anti-viral therapy liver biopsy should be repeated once or twice with 5-10-year intervals to ascertain fibrosis growth rate and, according to this, plan a most appropriate follow-up. Assuming hepatitis progresses rapidly in all HIV co-infected patients, anti-viral therapy could be administered with no previous LB; such biopsy would be performed in non-responders to decide their course of therapy.