Prediction of fibrosis progression in chronic viral hepatitis

• Published in: Clinical and molecular hepatology Vol. 20; no. 3; pp. 228 - 236
• Main Author: Wong, Grace Lai-Hung
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Association for the Study of the Liver 01.09.2014; The Korean Association for the Study of the Liver
• Subjects: Age Factors; Antiviral Agents - therapeutic use; Biomarkers - blood; Cirrhosis; Death; Fibroscan; Hepatic events; Hepatitis B; Hepatitis C; Hepatitis delta virus; Hepatitis, Chronic - drug therapy; Hepatitis, Chronic - pathology; Hepatitis, Viral, Human - drug therapy; Hepatitis, Viral, Human - pathology; Hepatocellular carcinoma; Humans; Liver - diagnostic imaging; Liver cancer; Liver Cirrhosis - pathology; Liver stiffness measurement; Orthohepadnavirus - genetics; Review; Risk Factors; Ultrasonography; Liver stiffness measurement; Cirrhosis; Death; Hepatocellular carcinoma; Fibroscan; Hepatic events
• ISSN: 2287-2728; 2287-285X; 2287-285X
• DOI: 10.3350/cmh.2014.20.3.228

Prediction of liver fibrosis progression has a key role in the management of chronic viral hepatitis, as it will be translated into the future risk of cirrhosis and its various complications including hepatocellular carcinoma. Both hepatitis B and C viruses mainly lead to fibrogenesis induced by chronic inflammation and a continuous wound healing response. At the same time direct and indirect profibrogenic responses are also elicited by the viral infection. There are a handful of well-established risk factors for fibrosis progression including older age, male gender, alcohol use, high viral load and co-infection with other viruses. Metabolic syndrome is an evolving risk factor of fibrosis progression. The new notion of regression of advanced fibrosis or even cirrhosis is now strongly supported various clinical studies. Even liver biopsy retains its important role in the assessment of fibrosis progression, various non-invasive assessments have been adopted widely because of their non-invasiveness, which facilitates serial applications in large cohorts of subjects. Transient elastography is one of the most validated tools which has both diagnostic and prognostic role. As there is no single perfect test for liver fibrosis assessment, algorithms combining the most validated noninvasive methods should be considered as initial screening tools.