Published online Oct 28, 2015. doi: 10.4254/wjh.v7.i24.2510
Peer-review started: May 15, 2015
First decision: June 23, 2015
Revised: July 18, 2015
Accepted: September 30, 2015
Article in press: October 9, 2015
Published online: October 28, 2015
Several non-invasive surrogate methods have recently challenged the main role of liver biopsy in assessing liver fibrosis in hepatitis C virus (HCV)-monoinfected and human immunodeficiency virus (HIV)/HCV-coinfected patients, applied to avoid the well-known side effects of liver puncture. Serological tests involve the determination of biochemical markers of synthesis or degradation of fibrosis, tests not readily available in clinical practice, or combinations of routine tests used in chronic hepatitis and HIV/HCV coinfection. Several radiologic techniques have also been proposed, some of which commonly used in clinical practice. The studies performed to compare the prognostic value of non-invasive surrogate methods with that of the degree of liver fibrosis assessed on liver tissue have not as yet provided conclusive results. Each surrogate technique has shown some limitations, including the risk of over- or under-estimating the extent of liver fibrosis. The current knowledge on liver fibrosis in HIV/HCV-coinfected patients will be summarized in this review article, which is addressed in particular to physicians involved in this setting in their clinical practice.
Core tip: The extent of liver fibrosis is a marker of disease progression influencing the clinical and therapeutic decisions to be made for human immunodeficiency virus (HIV)/hepatitis C virus (HCV)-coinfected patients. The international guidelines suggest anti-HCV therapy for HIV/HCV-coinfected patients with histological fibrosis score ≥ 2 in the Metavir scoring system since they have an increased risk of liver failure. Due to the high clinical impact of liver fibrosis and of the well-known limitations of liver biopsy, surrogate, non-invasive technologies have been researched. The pros and cons of liver biopsy and surrogate technologies in detecting liver fibrosis in HIV/HCV-coinfected patients will be discussed in this review article.