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Liver BiopsyLiver biopsy is the diagnostic gold standard for assessment of liver damage and its causes. However, experts are debating the requirement for a pre-treatment biopsy because of the rare but serious risks associated with biopsy (puncture of adjoining organs, hemorrhage and—very rarely—death),112-114 the possibility of sampling error,115,116 and patient reluctance. A liver biopsy is most useful for detecting mild to moderate liver damage, because more severe liver damage, cirrhosis, can be identified with clinical, laboratory, and radiographic testing. Requiring liver biopsy as a prerequisite for HCV treatment may create a barrier for some patients.
Although researchers are working to create a less invasive replacement for liver biopsy that uses panels of blood tests and imaging techniques, nothing has been validated for use in coinfected people. Given the limited efficacy and substantial side effects of HCV treatment, some providers feel that a biopsy is necessary to identify patients who can defer treatment. Others recommend biopsy for patients with genotype 1 and a high viral load because they are less likely to respond to treatment; biopsy may not be required for patients with genotype 2 or 3 because the likelihood that they will achieve an SVR is significantly greater.30,44,117
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