METAVIR Score F0-F1: Minimal to No Liver Fibrosis
A METAVIR score of F0-F1 indicates absent to minimal liver fibrosis, representing the earliest stages of liver disease with no significant scarring and an excellent prognosis. 1
Fibrosis Stage Classification
The METAVIR scoring system grades liver fibrosis on a five-point scale where:
- F0 = No fibrosis (completely normal liver architecture)
- F1 = Minimal fibrosis (portal fibrosis without septa)
- F2 = Moderate fibrosis (portal fibrosis with few septa)
- F3 = Severe fibrosis (numerous septa without cirrhosis)
- F4 = Cirrhosis 1
Patients with F0-F1 have no or mild disease, representing the least severe end of the fibrosis spectrum. 1
Clinical Significance and Prognosis
Low Risk Profile
F0-F1 patients are not at immediate risk for clinical decompensation and have an extremely low risk of hepatocellular carcinoma (HCC). 1 The median estimated time to cirrhosis progression in untreated hepatitis C patients with minimal fibrosis can exceed 30-42 years, and approximately 31% may never progress to cirrhosis. 2
Mortality and Morbidity Outcomes
In HIV/HCV coinfected patients, F0-F1 fibrosis stages demonstrate the lowest incidence of end-stage liver disease (ESLD), HCC, or death at 23.63-36.33 per 1000 person-years, compared to 79.43 per 1000 person-years for F4 cirrhosis. 3 This represents a 2-3 fold lower risk compared to patients with significant fibrosis (F2 or higher). 3
Treatment Implications in Hepatitis C
Treatment Priority
According to EASL guidelines, treatment for patients with F0-F1 and no severe extra-hepatic manifestations can be individualized and informed deferral is acceptable. 1 Treatment is justified (priority level A2) starting at F2 (moderate fibrosis), while F3-F4 patients require urgent prioritization (A1 recommendation). 1
Exceptions Requiring Treatment Despite F0-F1
Treatment should be prioritized regardless of F0-F1 status in:
- Patients at risk of HCV transmission (active injection drug users, men who have sex with men with high-risk practices, pregnant women, hemodialysis patients, incarcerated individuals) 1
- Clinically significant extra-hepatic manifestations (symptomatic vasculitis, cryoglobulinemia, HCV-related nephropathy, non-Hodgkin B cell lymphoma) 1
- HIV or HBV coinfection 1
- Debilitating fatigue 1
Quality of Life Considerations
In F0-F1 patients treated with interferon-free, ribavirin-free regimens, patient-reported outcomes improve both during treatment (+1.2 to +10.9 points) and after achieving sustained virologic response (+2.1 to +14.7 points). 4 This contrasts with interferon-containing regimens that cause significant quality of life deterioration during treatment. 4
Post-Treatment Management
Discharge Criteria After HCV Cure
Patients with F0-F1 who achieve sustained virologic response (SVR) can be safely discharged from specialized hepatology care to general practitioner follow-up. 1 Specifically:
- VCTE liver stiffness <8 kPa or FIB-4 <1.45 confirms minimal fibrosis and allows discharge 1
- Education on healthy lifestyle and alcohol avoidance should be emphasized before discharge 1
- If VCTE-LSM is 8-10 kPa and/or FIB-4 is 1.45-3.25, specialized care is recommended only if metabolic dysfunction-associated steatotic liver disease (MASLD) or harmful alcohol intake persists 1
Diagnostic Performance of Non-Invasive Tests
Non-invasive serum markers and elastography can differentiate F0-F1 from significant fibrosis (F2-F4) with AUROC scores of approximately 0.8-0.87. 1 For shear wave elastography in liver transplant recipients, a median velocity ≤1.76 m/s corresponds to F0-F1 with 96% negative predictive value. 5
Key Clinical Pitfall
The major caveat is that F0-F1 patients with ongoing cofactors (diabetes, alcohol consumption, metabolic syndrome) remain at risk for disease progression even after HCV cure. 1 Regular monitoring is essential if treatment is deferred or if cofactors persist after SVR. 1