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co-infected hiv/hcv
Feb 9, 2008

How often would you need to take a liver biobsy.

Response from Dr. McGovern

Good question. No clear answer.

We use to get liver biopsies every three years if no treatment was being considered. Then we started getting biopsies every two years since there is some data to suggest rapid fibrosis progression in some patients with coinfection.

There are also some data on the use of non-invasive markers (eg simple blood tests). However, there are limitations of these markers. They only tell you about scarring (fibrosis); they can't tell you about inflammation or fat in the liver, which is also helpful information. The other problem is that they are pretty good at telling you whether you have minimal or severe disease, but not good at anything in the middle. That is not to say that liver biopsies are great either - they can miss disease too.

I don't always get liver biopsies in patients with genotype 2 or 3 infection or genotype 1 patients with low viral loads. If the patient is motivated to be treated, then in these situations we sometimes start therapy and see how the virus is responding in the first four weeks. I do this because I think our markers are very imperfect and the viral load response is a great marker of potential sustained virologic outcome.

Hope this is helpful.



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