Histological and nonhistological criteria in the evaluation of liver involvement in chronic hepatitis C.

The treatment of chronic viral hepatitis is based mainly on interferon therapy. This therapy has many drawbacks, among which potentially dangerous side-effects. Moreover, the majority of the patients are asymptomatic at the time of diagnosis, and most of them will never develop cirrhosis, liver failure or hepatocellular carcinoma, making the decision to treat a difficult one. Currently, the best method of selection is liver biopsy, considered "the gold standard" for recommending antiviral treatment. The histological aspect can vary in different hepatic areas and the smaller the bioptic fragment, the more probable is the histopathologist's error in correctly defining the hepatitis. There has been made important progress in defining the degree of liver involvement using serological tests, with the purpose of avoiding liver biopsy, but this approach has not yet proven to be superior. At present, the benefits of the pretreatment liver biopsy outbalance the risks. The future developments in the domain of antiviral drugs or nonhistological tests for evaluating the liver injury (circulating cytokines, subtypes of collagen) will show if the liver biopsy could be abandoned.