Skip to main content

Advertisement

SpringerLink
Log in

Non-invasive Fibrosis Assessment of Patients with Hepatitis C: Application of Society Guidelines to Clinical Practice

  • Hepatitis C (H Vargas and S Flamm, Section Editors)
  • Published:
Current Hepatology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Chronic hepatitis C (CHC) infection remains a significant global public health burden and is associated with significant morbidity and mortality due to complications of cirrhosis, liver failure, and hepatocellular carcinoma (HCC). All oral direct-acting antivirals (DAAs) are associated with high rates of sustained virologic response (SVR). Pre-treatment assessment for liver fibrosis remains of high importance as it may impact treatment choice, treatment duration, and signal the presence of cirrhosis for which variceal screening and HCC surveillance are warranted.

Recent Findings

Non-invasive fibrosis assessment tools have largely replaced gold standard liver biopsy in routine clinical practice. Herein, we review key modalities of noninvasive testing with serum and imaging biomarkers, summarize current guideline recommendations, and propose an algorithm for real-world application in clinical practice.

Summary

Careful history and exam, laboratory assessment, liver imaging, and a two-test noninvasive fibrosis strategy can reliably identify cirrhosis in patients with CHC infection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Chhatwal J, et al. Hepatitis C disease burden in the United States in the era of oral direct-acting antivirals. Hepatology. 2016;64(5):1442–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Lavanchy D. The global burden of hepatitis C. Liver Int. 2009;29(Suppl 1):74–81.

    Article  Google Scholar 

  3. Stanaway JD, et al. The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013. Lancet. 2016;388(10049):1081–8.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Everhart JE, et al. Prognostic value of Ishak fibrosis stage: findings from the hepatitis C antiviral long-term treatment against cirrhosis trial. Hepatology. 2010;51(2):585–94.

    Article  PubMed  Google Scholar 

  5. Sebastiani G, Gkouvatsos K, Pantopoulos K. Chronic hepatitis C and liver fibrosis. World J Gastroenterol. 2014;20(32):11033–53.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Seeff LB, et al. Complication rate of percutaneous liver biopsies among persons with advanced chronic liver disease in the HALT-C trial. Clin Gastroenterol Hepatol. 2010;8(10):877–83.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Thampanitchawong P, Piratvisuth T. Liver biopsy: complications and risk factors. World J Gastroenterol. 1999;5(4):301–4.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Bedossa P, Dargere D, Paradis V. Sampling variability of liver fibrosis in chronic hepatitis C. Heptology. 2003;38(6):1449–57.

    Article  Google Scholar 

  9. Rockey DC, et al. Liver biopsy. Hepatology. 2009;49(3):1017–44.

    Article  Google Scholar 

  10. Regev A, et al. Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection. Am J Gastroenterol. 2002;97(10):2614–8.

    Article  Google Scholar 

  11. Jayakumar, S., S.A. Harrison, and L. R., Noninvasive markers of fibrosis and inflammation in nonalcoholic fatty liver disease. Current Hepatology Reports, 2016. 15(2): p. 86–95.

  12. Lizaola B, et al. Role of noninvasive fibrosis methods in management of chronic hepatitis B virus. Current Hepatology Reports. 2016;15(4):220–9.

    Article  Google Scholar 

  13. Weiskirchen R, Tacke F. The role of radiologic modalities in diagnosing nonalcoholic steatohepatitis (NASH) and fibrosis. Current Hepatology Reports. 2018;17(4):324–35.

    Article  Google Scholar 

  14. Lejealle C, Castera L. Non-invasive fibrosis testing in patients with chronic hepatitis B. Current Hepatology Reports. 2018;17(4):492–501.

    Article  Google Scholar 

  15. A national strategy for the elimination of hepatitis B and C: Phase Two Report, B.L. Strom and G. J. Buckley, Editors. 2017: Washington (DC).

  16. •• AASLD-IDSA HCV Guidance Panel. Hepatitis C Guidance 2018 Update: AASLD-IDSA Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection. Clin Infect Dis. 2018;67:1477–92 Major society guideline from the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America governing the evaluation and management of chronic hepatitis C infection.

    Article  CAS  Google Scholar 

  17. Marrero JA, et al. Diagnosis, staging, and management of hepatocellular carcinoma: 2018 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2018;68(2):723–50.

    Article  Google Scholar 

  18. •• European Association for the Study of the Liver. EASL Recommendations on Treatment of Hepatitis C 2018. J Hepatol, 2018. 69(2): p. 461–511. Major society guideline from the European Association for the study of the liver governing the evaluation and management of chronic hepatitis C infection.

  19. AASLD-IDSA HCV Guidance Panel. AASLD-IDSA recommendations for testing, managing, and treating adults infected with hepatitis C virus. Hepatology, 2015. 62(3): p. 932–954.

  20. Everhart JE, et al. Prognostic value of Ishak fibrosis stage: findings from the hepatitis C antiviral long-term treatment against cirrhosis trial. Hepatology. 2010;51(2):585–94.

    Article  PubMed  Google Scholar 

  21. European Association for the Study of the Liver. EASL clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2018;69(1):182–236.

    Article  Google Scholar 

  22. Ooka K, Connolly JJ, Lim JK. Medicaid reimbursement for oral direct antiviral agents for the treatment of chronic hepatitis C. Am J Gastroenterol. 2017;112(6):828–32.

    Article  PubMed  Google Scholar 

  23. Gowda C, et al. Absolute insurer denial of direct-acting antiviral therapy for hepatitis C: a National Specialty Pharmacy Cohort Study. Open Forum Infect Dis. 2018;5(6):ofy076.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Aube C, et al. Ultrasonographic diagnosis of hepatic fibrosis or cirrhosis. J Hepatol. 1999;30(3):472–8.

    Article  CAS  Google Scholar 

  25. Colli A, et al. Severe liver fibrosis or cirrhosis: accuracy of US for detection--analysis of 300 cases. Radiology. 2003;227(1):89–94.

    Article  PubMed  Google Scholar 

  26. Choong CC, Venkatesh SK, Siew EP. Accuracy of routine clinical ultrasound for staging of liver fibrosis. J Clin Imaging Sci. 2012;2:58.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Cohen EI, Wilck EJ, Shapiro RS. Hepatic imaging in the 21st century. Semin Liver Dis. 2006;26(4):363–72.

    Article  PubMed  Google Scholar 

  28. Talwalkar JA, et al. Magnetic resonance imaging of hepatic fibrosis: emerging clinical applications. Hepatology. 2008;47(1):332–42.

    Article  PubMed  Google Scholar 

  29. Kanwal F, et al. Hepatitis C virus infection care pathway-a report from the American Gastroenterological Association Institute HCV Care Pathway Work Group. Gastroenterology. 2017;152(6):1588–98.

    Article  PubMed  Google Scholar 

  30. •• Shiha G, et al. Asian-Pacific Association for the Study of the Liver (APASL) consensus guidelines on invasive and non-invasive assessment of hepatic fibrosis: a 2016 update. Hepatol Int. 2017;11(1):1–30 Major society guideline from the Asian Pacific Association for the Study of the liver governing the evaluation and management of chronic hepatitis C infection.

    Article  PubMed  Google Scholar 

  31. Trivedi HD, Patwardhan VR, Malik R. Chronic hepatitis C infection – noninvasive assessment of liver fibrosis in the era of direct acting antivirals. Dig Liver Dis. 2019;51:183–9.

    Article  PubMed  Google Scholar 

  32. • Chou R, Wasson N. Blood tests to diagnosis fibrosis or cirrhosis in patients with chronic hepatitis C virus infection: a systematic review. Ann Intern Med. 2013;158:807–20 Comprehensive systematic review summarizing evidence base for noninvasive serum markers for the diagnosis of liver fibrosis or cirrhosis in patients with chronic hepatitis C infection.

    Article  Google Scholar 

  33. Houot M, Ngo Y, Munteanu M, Marque S, Poynard T. Systematic review with meta-analysis: direct comparisons of biomarkers for the diagnosis of fibrosis in chronic hepatitis C or B. Aliment Pharmacol Ther. 2016;43:16–29.

    Article  CAS  PubMed  Google Scholar 

  34. Shaheen AA, Wan AF, Myers RP. FibroTest and FibroScan for the prediction of hepatitis C-related fibrosis: a systematic review of diagnostic test accuracy. Am J Gastroenterol. 2007;102:2589–600.

    Article  PubMed  Google Scholar 

  35. Castera L, et al. Noninvasive methods to assess liver disease in patients with hepatitis B or C. Gastroenterology. 2012;142:1293–302.

    Article  PubMed  Google Scholar 

  36. Fraquelli M, et al. Reproducibility of transient elastography in the evaluation of liver fibrosis in patients with chronic liver disease. Gut. 2007;56(7):968–73.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Arena U, et al. Liver stiffness is influenced by a standardized meal in patients with chronic hepatitis C virus at different stages of fibrotic evolution. Hepatology. 2013;58(1):65–72.

    Article  CAS  PubMed  Google Scholar 

  38. Arena U, et al. Reliability of transient elastography for the diagnosis of advanced fibrosis in chronic hepatitis C. Gut. 2008;57(9):1288–93.

    Article  CAS  PubMed  Google Scholar 

  39. Vispo E, et al. Overestimation of liver fibrosis staging using transient elastography in patients with chronic hepatitis C and significant liver inflammation. Antivir Ther. 2009;14(2):187–93.

    PubMed  Google Scholar 

  40. Millonig G, et al. Liver stiffness is directly influenced by central venous pressure. J Hepatol. 2010;52(2):206–10.

    Article  PubMed  Google Scholar 

  41. Millonig G, et al. Extrahepatic cholestasis increases liver stiffness (FibroScan) irrespective of fibrosis. Hepatology. 2008;48(5):1718–23.

    Article  PubMed  Google Scholar 

  42. Arena U, et al. Acute viral hepatitis increases liver stiffness values measured by transient elastography. Hepatology. 2008;47(2):380–4.

    Article  CAS  PubMed  Google Scholar 

  43. Tapper EB, Castera L, Afdhal NH. FibroScan (vibration-controlled transient elastography): where does it stand in the United States practice. Clin Gastroenterol Hepatol. 2015;13:27–36.

    Article  PubMed  Google Scholar 

  44. Degos F, et al. Diagnostic accuracy of FibroScan and comparison to liver fibrosis biomarkers in chronic viral hepatitis: a multicenter prospective study (the FIBROSTIC study). J Hepatol. 2010;53(6):1013–21.

    Article  PubMed  Google Scholar 

  45. Zarski JP, et al. Comparison of nine blood tests and transient elastography for liver fibrosis in chronic hepatitis C: the ANRS HCEP-23 study. J Hepatol. 2012;56(1):55–62.

    Article  PubMed  Google Scholar 

  46. Castera L, et al. Pitfalls of liver stiffness measurement: a 5-year prospective study of 13,369 examinations. Hepatology. 2010;51(3):828–35.

    PubMed  Google Scholar 

  47. Sandrin L, et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol. 2003;29(12):1705–13.

    Article  Google Scholar 

  48. Castera L, et al. Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C. Gastroenterology. 2005;128(2):343–50.

    Article  PubMed  Google Scholar 

  49. Ziol M, et al. Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C. Hepatology. 2005;41(1):48–54.

    Article  PubMed  Google Scholar 

  50. Shaheen AA, Wan AF, Myers RP. FibroTest and FibroScan for the prediction of hepatitis C-related fibrosis: a systematic review of diagnostic test accuracy. Am J Gastroenterol. 2007;102(11):2589–600.

    Article  PubMed  Google Scholar 

  51. Friedrich-Rust M, et al. Performance of transient elastography for the staging of liver fibrosis: a meta-analysis. Gastroenterology. 2008;134(4):960–74.

    Article  Google Scholar 

  52. Afdhal NH, et al. Accuracy of fibroscan, compared with histology, in analysis of liver fibrosis in patients with hepatitis B or C: a United States multicenter study. Clin Gastroenterol Hepatol. 2015;13(4):772–9 e1-3.

    Article  PubMed  Google Scholar 

  53. Erman A, Sathya A, Nam A, Bielecki JM, Feld JJ, Thein HH, et al. Estimating chronic hepatitis C prognosis using transient elastography-based liver stiffness: a systematic review and meta-analysis. J Viral Hepat. 2018;25:502–13.

    Article  CAS  PubMed  Google Scholar 

  54. Ying HY, Lu LG, Jing DD, Ni XS. Accuracy of trainset elastography in the assessment of chronic hepatitis C-related liver cirrhosis. Clin Invest Med. 2016;39:E150–60.

    Article  PubMed  Google Scholar 

  55. Njei B, McCarty TR, Luk J, Ewelukwa O, Ditah I, Lim JK. Use of transient elastography in patients with HIV-HCV coinfection: a systematic review and meta-analysis. J Gastorenterol Hepatol. 2016;31:1684–93.

    Article  Google Scholar 

  56. Singh S, Fujii LL, Murad MH, Wang Z, Asrani SK, Ehman RL, et al. Liver stiffness is associated with risk of decompensation, liver cancer, and death in patients with chronic liver diseases: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2013;11:1573–84.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Bercoff J, Tanter M, Fink M. Supersonic shear imaging: a new technique for soft tissue elasticity mapping. IEEE Trans Ultrason Ferroelectr Freq Control. 2004;51(4):396–409.

    Article  PubMed  Google Scholar 

  58. Muller M, et al. Quantitative viscoelasticity mapping of human liver using supersonic shear imaging: preliminary in vivo feasibility study. Ultrasound Med Biol. 2009;35(2):219–29.

    Article  PubMed  Google Scholar 

  59. Abe T, Kuroda H, Fujiwara Y, Yoshida Y, Miyasaka A, Kamiyama N, et al. Accuracy of 2D shear wave elastography in the diagnosis of liver fibrosis in patients with chronic hepatitis C. J Clin Ultrasound. 2018;46:319–27.

    Article  PubMed  Google Scholar 

  60. Verlinden W, Bourgeois S, Gigase P, Thienpont C, Vonghia L, Vanwolleghem T, et al. Liver fibrosis evaluation using real-time shear wave elastography in hepatitis C-monoinfected and human immunodeficiency virus/hepatitis C-coinfected patients. J Ultrasound Med. 2016;35:1299–308.

    Article  PubMed  Google Scholar 

  61. Yoneda M, et al. Supersonic shear imaging and transient elastography with the XL probe accurately detect fibrosis in overweight or obese patients with chronic liver disease. Clin Gastroenterol Hepatol. 2015;13(8):1502–9 e5.

    Article  PubMed  Google Scholar 

  62. Ferraioli G, et al. Reproducibility of real-time shear wave elastography in the evaluation of liver elasticity. Eur J Radiol. 2012;81(11):3102–6.

    Article  PubMed  Google Scholar 

  63. Gersak MM, et al. Influence of food intake on 2-D shear wave elastography assessment of liver stiffness in healthy subjects. Ultrasound Med Biol. 2016;42(6):1295–302.

    Article  PubMed  Google Scholar 

  64. Gradinaru-Tascau O, et al. Does experience play a role in the ability to perform liver stiffness measurements by means of supersonic shear imaging (SSI)? Med Ultrason. 2013;15(3):180–3.

    Article  PubMed  Google Scholar 

  65. Yamada R, Hiramatsu N, Oze T, Morishita N, Harada N, Miyazaki M, et al. Significance of liver stiffness measurement by acoustic radiation force impulse (ARFI) among hepatitis C patients. J Med Virol. 2014;86:241–7.

    Article  CAS  PubMed  Google Scholar 

  66. Frulio N, Trillaud H, Perez P, Asselineau J, Vandenhende M, Hessamfar M, et al. Acoustic radiation force impulse (ARFI) and transient elastography for evaluation of liver fibrosis in HIV-HCV coinfected patients. BMC Infect Dis. 2014;14:405.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Hu X, Qiu L, Liu D, Qian L. Acoustic radiation force impulse elastography for non-invasive evaluation of hepatic fibrosis in chronic hepatitis B and C patients: a systematic review and meta-analysis. Med Ultrason. 2017;19:23–31.

    Article  PubMed  Google Scholar 

  68. Lopez JJ, Perez-Alvarez N, Rodriguez RV, Jou A, Carbonell P, Jimenez JA, et al. Optimal use of transient elastography and acoustic radiation force impulse to stage liver fibrosis in HIV/HCV-coinfected patients in clinical practice. J Ultrasound Med. 2018;37:113–21.

    Article  PubMed  Google Scholar 

  69. Popescu A, et al. The influence of food intake on liver stiffness values assessed by acoustic radiation force impulse elastography-preliminary results. Ultrasound Med Biol. 2013;39(4):579–84.

    Article  PubMed  Google Scholar 

  70. Bota S, et al. The influence of aminotransferase levels on liver stiffness assessed by acoustic radiation force impulse elastography: a retrospective multicentre study. Dig Liver Dis. 2013;45(9):762–8.

    Article  CAS  PubMed  Google Scholar 

  71. Huwart L, et al. Liver fibrosis: non-invasive assessment with MR elastography. NMR Biomed. 2006;19(2):173–9.

    Article  PubMed  Google Scholar 

  72. Huwart L, et al. Magnetic resonance elastography for the noninvasive staging of liver fibrosis. Gastroenterology. 2008;135(1):32–40.

    Article  PubMed  Google Scholar 

  73. Rouviere O, et al. MR elastography of the liver: preliminary results. Radiology. 2006;240(2):440–8.

    Article  PubMed  Google Scholar 

  74. Rouviere O, et al. MR elastography of the liver: preliminary results. Radiology. 2006;240(2):440–8.

    Article  PubMed  Google Scholar 

  75. Wang QB, et al. Performance of magnetic resonance elastography and diffusion-weighted imaging for the staging of hepatic fibrosis: a meta-analysis. Hepatology. 2012;56(1):239–47.

    Article  PubMed  Google Scholar 

  76. Ichikawa S, et al. Magnetic resonance elastography for staging liver fibrosis in chronic hepatitis C. Magn Reson Med Sci. 2012;11(4):291–7.

    Article  PubMed  Google Scholar 

  77. Su LN, et al. Diagnostic value of magnetic resonance elastography for detecting and staging of hepatic fibrosis: a meta-analysis. Clin Radiol. 2014;69(12):e545–52.

    Article  PubMed  Google Scholar 

  78. Singh S, et al. Diagnostic performance of magnetic resonance elastography in staging liver fibrosis: a systematic review and meta-analysis of individual participant data. Clin Gastroenterol Hepatol. 2015;13(3):440–451 e6.

    Article  PubMed  Google Scholar 

  79. • Singh S, et al. American Gastroenterological Association Institute technical review on the role of elastography in chronic liver diseases. Gastroenterology. 2017;152(6):1544–77 Technical review summarizing available evidence for serum fibrosis markers and liver elastography for assessment of liver cirrhosis in patients with chronic hepatitis C infection.

    Article  PubMed  Google Scholar 

  80. O'Brien TR, et al. Genetic factors that affect spontaneous clearance of hepatitis C or B virus, response to treatment, and disease progression. Gastroenterology. 2018.

  81. Matsuura K, Tanaka Y. Host genetic variations associated with disease progression in chronic hepatitis C virus infection. Hepatol Res. 2018;48(2):127–33.

    Article  PubMed  Google Scholar 

  82. Estrabaud E, et al. Genomics and HCV infection: progression of fibrosis and treatment response. J Hepatol. 2012;57(5):1110–25.

    Article  CAS  PubMed  Google Scholar 

  83. Romero-Gomez M, et al. Genes and hepatitis C: susceptibility, fibrosis progression and response to treatment. Liver Int. 2011;31(4):443–60.

    Article  CAS  PubMed  Google Scholar 

  84. Noureddin M, et al. Association of IL28B genotype with fibrosis progression and clinical outcomes in patients with chronic hepatitis C: a longitudinal analysis. Hepatology. 2013;58(5):1548–57.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  85. Eslam M, et al. FibroGENE: a gene-based model for staging liver fibrosis. J Hepatol. 2016;64(2):390–8.

    Article  CAS  PubMed  Google Scholar 

  86. Huang H, et al. A 7 gene signature identifies the risk of developing cirrhosis in patients with chronic hepatitis C. Hepatology. 2007;46(2):297–306.

    Article  CAS  PubMed  Google Scholar 

  87. Marcolongo M, et al. A seven-gene signature (cirrhosis risk score) predicts liver fibrosis progression in patients with initially mild chronic hepatitis C. Hepatology. 2009;50(4):1038–44.

    Article  CAS  PubMed  Google Scholar 

  88. •• European Association for Study of Liver Diseases and H. Asociacion Latinoamericana para el Estudio del, EASL-ALEH Clinical practice guidelines: non-invasive tests for evaluation of liver disease severity and prognosis. J Hepatol, 2015. 63(1): p. 237–64. Major society guideline from EASL and ALEH governing the use of noninvasive tests for assessment of liver fibrosis and cirrhosis.

  89. •• Lim JK, et al. American Gastroenterological Association Institute Guideline on the role of elastography in the evaluation of liver fibrosis. Gastroenterology. 2017;152(6):1536–43 Major society guideline from the American Gastroenterological Association governing the role of liver elastography in the evaluation of liver fibrosis and cirrhosis.

    Article  PubMed  Google Scholar 

  90. Chou R, Wasson N. Blood tests to diagnose fibrosis or cirrhosis in patients with chronic hepatitis C virus infection: a systematic review. Ann Intern Med. 2013;158(11):807–20.

    Article  Google Scholar 

  91. Castera L, et al. Prospective comparison of two algorithms combining non-invasive methods for staging liver fibrosis in chronic hepatitis C. J Hepatol. 2010;52(2):191–8.

    Article  PubMed  Google Scholar 

  92. Castera L, et al. Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C. Gastroenterology. 2005;128(2):343–50.

    Article  PubMed  Google Scholar 

  93. Sebastiani G, et al. Comparison of three algorithms of non-invasive markers of fibrosis in chronic hepatitis C. Aliment Pharmacol Ther. 2012;35(1):92–104.

    Article  CAS  PubMed  Google Scholar 

  94. Sebastiani G, et al. SAFE biopsy: a validated method for large-scale staging of liver fibrosis in chronic hepatitis C. Hepatology. 2009;49(6):1821–7.

    Article  PubMed  Google Scholar 

  95. • Jacobson IM, Lim JK, Fried MW. American Gastroenterological Association Institute clinical practice update-expert review: care of patients who have achieved a sustained virologic response after antiviral therapy for chronic hepatitis C infection. Gastroenterology. 2017;152(6):1578–87 Guidance document from the American Gastroenterological Association with best practice advice on the management of patients with chronic hepatitis C infection who have achieved sustained virologic response (SVR).

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA

    James C. Connolly

  2. Yale Liver Center and Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA

    Joseph K. Lim

  3. Yale Viral Hepatitis Program, Yale University School of Medicine, 333 Cedar Street, LMP 1080, New Haven, CT, 06520-8019, USA

    Joseph K. Lim

Authors
  1. James C. Connolly
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joseph K. Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joseph K. Lim.

Ethics declarations

Conflict of Interest

Joseph K. Lim reports grants from Allergan, AbvVie, Conatus, Genfit, and Intercept, as well as grants and personal fees from Gilead outside the submitted work.

James C. Connolly declares no potential conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Hepatitis C

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Connolly, J.C., Lim, J.K. Non-invasive Fibrosis Assessment of Patients with Hepatitis C: Application of Society Guidelines to Clinical Practice. Curr Hepatology Rep 18, 249–258 (2019). https://doi.org/10.1007/s11901-019-00471-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11901-019-00471-3

Keywords

Search

Navigation