Evaluation of fibrosis progression is useful to decide treatment. Among patients with sustained viral response, fibrosis regresses. Evaluation of fibrosis progression has permitted validation of the concept of suppressive therapy. Among patients without viral clearance, interferon alone or in combination with ribavirin significantly reduces fibrosis progression rate in comparison with progression before treatment and to control groups. There is a major need for noninvasive markers of liver fibrosis.
None are clearly useful today for the diagnosis of early stages of fibrosis.
Cumulative evidence strongly suggests that the increase in mortality due to hepatocellular carcinoma in most Western countries is due to hepatitis C infection. Fibrosis is the deleterious but variable consequence of chronic inflammation. It is characterized by the deposition of extracellular matrix components, leading to the distortion of the hepatic architecture with impairment of liver microcirculation and liver cell function. HCV is usually only lethal when it leads to cirrhosis, the last stage of liver fibrosis. Therefore, an estimate of fibrosis progression represents an important surrogate end point for evaluation of the vulnerability of an individual patient and for assessment of the impact of treatment on natural history.