Dear Editor:
I recently had a 45 year old
female with hepatitis C type 2a who I recommended take therapy once the
new ribavirin prodrug is released and forgo a liver biopsy. She went for
a second opinion and they recommended a biopsy before any therapy. In general
with type 2 patients, would you recommend not doing a biopsy prior to
initiating therapy because of the generally good response to therapy?
G S
Dear GS:
The role of liver biopsy is in evolution, but most providers do not recommend
routine liver biopsy for patients with genotypes 2 or 3 since the sustained
virological response rate is so high (75-80%) and therapy is easier (6 months
of therapy and 800 mg/d of ribavirin). Thus, my practice habit, and my
colleagues, is to offer therapy without biopsy. The only special circumstances
leading to the recommendation of a liver biopsy might be suspicion of a
coexistent liver disease, such as NAFLD or alcoholic liver disease, or suspicion
of advanced fibrosis or cirrhosis, such as low normal platelet count or a rare
spider angioma on examination. Management might be influenced by these
additional findings, e.g., screening for HCC if cirrhosis is present.