From the Guidelines
In patients with F2 F3 liver fibrosis, a vibration-controlled transient elastography (VCTE) cutoff of 9.5 kPa can be used to rule out advanced liver fibrosis, as recommended by the American Gastroenterological Association (AGA) 1. This approach is based on a study that evaluated the diagnostic performance of VCTE in adults with HCV who achieved sustained virologic response (SVR) with antiviral therapy 1. The study found that using a cutoff of 9.5 kPa, the pooled sensitivity was 0.78 and pooled specificity was 0.86 for excluding F3F4 fibrosis 1. However, it is essential to note that this recommendation is based on conditional and very-low-quality evidence 1. Some key points to consider in the management of F2 F3 liver fibrosis include:
- Treating the underlying cause of liver disease, such as using antiviral medications for viral hepatitis 1
- Preventing further progression of liver disease through lifestyle modifications, such as weight loss and regular exercise, for non-alcoholic fatty liver disease (NAFLD) 1
- Regular monitoring with liver function tests and imaging to assess progression 1
- Considering the potential for reversibility of F2 F3 fibrosis with appropriate treatment, as the liver has regenerative capacity when the injurious stimulus is removed 1. It is crucial to weigh the benefits and risks of continued specialty care versus discharge from the specialty clinic, taking into account individual patient values and preferences 1.
From the Research
F2 F3 Liver Fibrosis
- F2 and F3 liver fibrosis are stages of liver fibrosis characterized by the accumulation of excessive extracellular matrix components, which can lead to cirrhosis, liver cancer, and liver failure 2.
- The diagnosis of liver fibrosis is typically done through liver biopsy, but non-invasive methods such as transient elastography and magnetic resonance (MR)-elastography are also used 2.
- Treatment of liver fibrosis is still in its early stages, with no specific antifibrotic therapies available, but several potential drugs are currently in phase II and III trials 2.
- The treatment efficacy of liver fibrosis can be evaluated by histological staining methods, imaging methods, and serum biomarkers, as well as fibrosis scoring systems, such as fibrosis-4 index, aspartate aminotransferase to platelet ratio, and non-alcoholic fatty liver disease fibrosis score 3.
Stages of Liver Fibrosis
- F2 fibrosis is characterized by the presence of fibrous septa, which can lead to the formation of nodules and eventually cirrhosis 4.
- F3 fibrosis is characterized by the presence of bridging fibrosis, which can lead to the formation of cirrhosis and liver failure 4.
- The progression of liver fibrosis can be influenced by various factors, including host and viral factors, and the stage of fibrosis can be used to predict the risk of advanced disease, including liver failure, cirrhosis, and hepatocellular carcinoma (HCC) 4.
Treatment and Outcomes
- The treatment of liver fibrosis with direct-acting antivirals (DAAs) has been shown to improve liver stiffness and non-invasive fibrosis scores in patients with chronic hepatitis C virus (HCV) infection 5.
- The eradication of HCV infection with DAAs has been associated with non-progression or regression of liver fibrosis, and improvement in health-related quality of life (HRQL) and work productivity, regardless of the stage of fibrosis 5, 6.
- However, advanced fibrosis has been associated with impairment of HRQL and work productivity, and the improvement of HRQL and work productivity after viral clearance was not related to the stage of fibrosis 6.