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Guided by Fibrosis Stage

When to start treatment for hepatitis C can be a hotly debated topic, with sicker patients generally moved to the front of the line. However, the question remains: “how can we identify who are the ‘sicker patients’?”

An effective way to identify which hepatitis C patients should get the most prompt treatment, say researchers from the Centers for Disease Control and Prevention (CDC), is with biopsy-based fibrosis staging. Patients who show early indicators of their liver disease progressing have more to gain from early treatment. In addition, these patients with progressive liver damage would be harmed the most from any delay in treatment.

These CDC researchers reviewed liver biopsies in 2,800 patients in the Chronic Hepatitis Cohort Study (CHeCS) and noted the health of this group over a five-year period. It was determined that the fibrosis stage for each patient at the start of the observation period was predictive of later health. Patients with a fibrosis stage of F4 saw a 37.2% risk of progressing to liver decompensation or liver cancer. Patients in the F3 stage had a risk of 19.6% of these dangerous outcomes. For F2 and F0/F1 patients, their risks were 4.7% and 2.3%, respectively.

Another important factor to take into consideration is whether a patient with hepatitis C is also co-infected with HIV. In such cases, the HIV is known to present a significant risk of accelerated fibrosis progression. Thus, both fibrosis and the presence of HIV co-infection should be considered in the timing of hepatitis C treatment.

Any fibrosis level is not without risk to later disease progression, but the CHeCS research reveals that fibrosis staging can be used to better understand which hepatitis C patients should be treated earlier. All chronic hepatitis C patients stand to benefit from treatment and this is especially true for those with higher fibrosis staging and HIV co-infection.


Grint D, et al. Liver-related death among HIV/hepatitis C-virus-co-infected individuals: implications for the era of directly acting antivirals. AIDS 2015;29:1205-15.

Xu F, Moorman AC, Tong X, et al. All-cause mortality and progression risks to hepatic decompensation and hepatocellular carcinoma in patients infected with hepatitis C. Clin Infect Dis October 19, 2015 (in press).

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