, Volume 43, Issue 7, pp 1562-1565

Value of Liver Biopsy Prior to Interferon Therapy for Chronic Viral Hepatitis

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Abstract

The present study prospectively evaluated thevalue of liver biopsy in patients with chronic hepatitisB (N = 75) and C (N = 135) prior to interferon therapy.Biopsy specimens revealed cirrhosis in 26% of patients with hepatitis B and 30% withhepatitis C. Although cirrhosis was not predictable bylaboratory values in individual patients mean gamma-GT,alkaline phosphatase, and bilirubin levels weresignificantly higher in patients with cirrhosis compared tothose without. Since cirrhosis significantly impairs theresponse rate to interferon therapy in hepatitis C butnot in hepatitis B, liver biopsy is important for the management of chronic hepatitis Cinfection. In 88% of patients with serum HBV-DNA,irrespective of the serum HBeAg status, chronic activehepatitis was seen. Similarly, chronic active hepatitis was found in 84% of patients with elevatedaminotransferases and hepatitis C antibodies. Thus,chronic active hepatitis was diagnosed in the majorityof cases with chronic viral hepatitis, showing that this histopathological diagnosis is of littleadditional value for the recommendation on interferontreatment in these patients. However, none of the othergrading systems of liver biopsy specimens described so far have been evaluated for their ability topredict overall prognosis or response rates tointerferon therapy. Therefore, the physician ispresently left with the questionable value of aprocedure with well-known risks and costs in patients suitablefor interferon treatment. Hence, prospective randomizedcontrolled studies to evaluate histopathological gradingsystems are urgently needed to redefine the necessity of liver biopsy in this routineclinical setting.