Biomarkers of fibrosis and impaired liver function in chronic hepatitis C: how well do they predict clinical outcomes?

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Abstract
To review the recent literature on the prognostic value of biomarkers of liver fibrosis and impaired liver function in patients with chronic hepatitis C with or without HIV coinfection.A combination of standard blood tests seems to be useful in identifying patients at risk of liver-related complications. Findings from studies investigating the validity of the Model for End-Stage Liver Disease (MELD) score in HIV-infected liver transplant candidates are conflicting. Two large studies of HIV/hepatitis C virus (HCV) coinfected patients have shown that plasma levels of the fibrosis marker hyaluronic acid are a strong predictor of clinical complications. A smaller study found hyaluronic acid and two other fibrosis tests, aspartate aminotransferase-to-platelet ratio index (APRI) and Fib-4, to be independent predictors of mortality when included in models with the MELD or the Child-Pugh-Turcotte scores.Although the data are still limited, recent findings from large studies of the prognostic ability of fibrosis markers in hepatitis C patients provides hope that fibrosis markers, together with other noninvasive methods, one day, will replace liver biopsy as the gold standard for the prognostic evaluation of liver disease. The MELD score, and other prognostic factors, need further evaluation in HIV/HCV coinfected patients with end-stage liver disease.