To the Editor: Chronic hepatitis C (HCV) infection affects more than 200 000 Australians.1 As the degree of hepatic fibrosis is the best predictor of morbidity, liver biopsy has a central role in management. Biopsy is also carried out to exclude additional pathology. However, because liver biopsy carries real risks and is expensive,2,3 debate exists as to whether liver biopsy should be performed routinely.3,4 Despite controversy surrounding the need to treat patients with minor histological changes,4 our impression is that many informed patients request treatment irrespective of liver histology. In Australia, liver biopsy is a prerequisite for antiviral therapy under the Pharmaceutical Benefits Scheme Highly Specialised Drugs Program (Box).5
The full article is accessible to AMA members and paid subscribers. Login to read more or purchase a subscription now.
Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.
- Department of Medicine, University of Western Australia at Fremantle Hospital, PO Box 480, Fremantle, WA 6959.
- 1. Law MG. Modeling the hepatitis C virus epidemic in Australia. J Gastroenterol Hepatol 1999; 14: 1100-1107.
- 2. Janes CH, Lindor KD. Outcome of patients hospitalized for complications after outpatient liver biopsy. Ann Intern Med 1993; 118: 96-98.
- 3. Saadeh S, Cammell G, Carey WD, et al. The role of liver biopsy in chronic hepatitis C. Hepatology 2001; 33: 196-200.
- 4. Poynard T, Ratziu V, Benmanov, et al. Fibrosis in patients with chronic hepatitis C: detection and significance. Semin Liver Dis 2000; 20: 47-55.
- 5. National Health Act 1953 (Cwlth), s 100.
- 6. Imbert-Bismut F, Ratziu V, Pieroni L, et al. Biochemical markers of liver fibrosis in patients with hepatitis C virus infection: a prospective study. Lancet 2000; 357: 1069-1075.