Pathogenesis of Fibrosis with Chronic Hepatitis C: Hepatic fibrosis is a dynamic scarring process in which chronic inflammation stimulates production and accumulation of collagen and extracellular matrix proteins. The hepatic stellate cells are the primary cells responsible for producing these extracellular matrix proteins. Over time, with chronic hepatitis C infection, the total collagen content increases and fibrosis can develop, with potential progression to cirrhosis. This dynamic process can also involve remodeling and regression of the fibrous tissue via breakdown of the matrix proteins by the protease enzymes matrix metalloproteinases (MMP). Balance of the remodeling process occurs with inhibition of the remodeling by tissue inhibitors of matrix metalloproteinases (TIMP).
General Approach to Evaluating Liver Fibrosis: Fibrosis is a precursor to cirrhosis and establishing the severity of liver fibrosis may help predict liver-related morbidity and mortality and emergence of complications of portal hypertension. Noninvasive methods to estimate hepatitis fibrosis are commonly used in clinical practice and these methods include indirect biomarkers, direct biomarkers, and imaging modalities. If noninvasive methods provide a clear-cut assessment of hepatic fibrosis then further assessment with liver biopsy may not be needed. Nevertheless, the most accurate and reliable evaluation of hepatic fibrosis remains liver biopsy with histologic analysis.