Ask Your Questions About-HCV! of our Hepatitis Experts:

Liver Biopsy in Coinfection

Dr Chung,

How important is it for a co-infected person (HIV HCV) to have a liver biopsy especially if they are totally asymptomatic and have no elevated liver enzymes. What are the risks versus benefits of having a biopsy considering the above situation?

Thank you,
A.

Dr. Chung writes--

The biopsy is generally important to know for prognosis and for determining whether antiviral therapy for HCV is warranted. For instance if the biopsy shows normal or near normal picture, and your genotype is 1, I would argue that you could justifiably wait for better and more proved therapies (from Jules: if you defer therapy, since you have coinfection I would be careful about monitoring your stage of disease)

On the other hand if you have advanced disease or cirrhosis, treatment should not be delayed. In patients with normal enzymes the damage tends to be less, but this is not true of all such patients (from Jules: a percentage of patients with normal ALT can have moderate ot more advanced liver disease and be candidates for treatment); thus biopsy may still be warranted. (from Jules: as you may know, liver disease may progress more quickly when person also has HIV.)

That's a reason to get a biopsy even if ALT is normal. Several small studies in coinfected persons showed normal ALT and moderate or advanced liver disease in some patients). The bleeding risk is in the range of 1 in 300 cases. (from Jules: most hepatologists I know & respect say a biopsy is the only way to diagnose accurately the stage of liver disease. Several docs I know say they are willing to treat for HCV without the biopsy).

- RC