Liver biopsy in hepatitis C: reassessing its role in 2001

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