Expert consensus recommends liver biopsy before therapy for chronic hepatitis C.
A cost effectiveness analysis suggested that the best strategy in the management of patients was to treat without biopsy.
Dr Andriulli and colleagues undertook a study to compare therapy in patients who did, or did not undergo biopsy.
The researchers separated participants into two groups:
Group A were Hepatitis C virus (HCV)-positive patients (78) who did not agree to (n = 57) or with contraindications to liver biopsy (n = 21).
Group B consisted of participants who consented to liver biopsy.
The researchers matched all participants for age, sex and genotype.
The investigators made a clinical diagnosis of chronic hepatitis on the basis of standard biochemical and ultrasonographic parameters before therapy (interferon/ribavirin for 12 months).
|Virological clearance after therapy can be achieved irrespective of whatever a liver biopsy might show|
|Journal of Viral Hepatitis|
The researchers noted that the two groups showed similar baseline characteristics.
The investigators made a noninvasive, diagnosis of chronic hepatitis in 75.6% of Group A, and in 83.3% of Group B.
Concordance between clinical and histological diagnosis in group B amounted to 91%.
The research group found that end-of-therapy virological response was 52.6% in Group A, and 57.7% in Group B.
Sustained virological response was 41.0% and 43.6% in the two groups.
The research group used noninvasive diagnosis of chronic hepatitis, lack of portal hypertension, platelets >105/mm3, prothrombin >70%, and genotype 2 or 3 as predictors of sustained response.
At multivariate analysis, genotype and platelets maintained their predictive power.
Dr Andriulli concluded, "In most patients with HCV infection, virological clearance after therapy can be achieved irrespective of whatever a liver biopsy might show."