Rebiopsy in patients with untreated hepatitis C: a useful procedure.

Background: The progression of fibrosis in the early stages of chronic hepatitis C virus is variable, and the ideal interval to perform a new biopsy in untreated patients is still unknown.

Aims: We evaluated the histologic progression of patients with untreated hepatitis C virus with two liver biopsies and correlated disease progression with demographic, epidemiologic, biochemical, and histologic variables.

Patients And Methods: Untreated hepatitis C virus-infected patients with two liver biopsies at a minimum interval of 1 year were studied. Gender, age, parenteral risk factors, duration of infection, alcohol intake, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyltransferase, and histologic findings were analyzed.

Results: Fifty-five patients were included. The first biopsy showed low grades of fibrosis and periportal necroinflammatory activity in 93%. A second biopsy was performed after 39 +/- 14 months; 40% of patients showed a progression of fibrosis and/or periportal necroinflammation. Comparison between groups with and without histologic worsening revealed no differences in demographic, epidemiologic, biochemical, or histologic data.

Conclusions: Histologic worsening occurred in 40% of untreated patients after 3.2 years. No factor could be established at the first biopsy to predict which patients are at risk of progression. Thus, histologic reassessment between 3 and 5 years seems to be the only approach to document disease progression and establish treatment indication.