Approximately 66% of the biopsies in my practice are for the staging of hepatitis C, but it is worthwhile emphasizing that not everyone with chronic viral hepatitis needs a biopsy. If there are absolute contraindications to antiviral treatment, why do a 'pretreatment' biopsy? Likewise, someone with gem> type 2 or 3 hepatitis C has such a high probability of virological cure with treatment that routine pretreatment biopsy is not recommended (3). If risk factor analysis indicates that the hepatitis C has been present in the patient for fewer than 10 years, and in the absence of confounders such as alcohol abuse or obesity, the chances of severe fibrosis are very small and a trial of treatment without a biopsy for staging may be appropriate.
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