Role of liver biopsy in the evaluation of hepatitis C virus infection in HIV coinfection.

Hepatitis C virus (HCV) coinfection is common in patients infected with human immunodeficiency virus (HIV), because the viruses share common routes of transmission. With the marked increase in life expectancy of HIV-infected patients associated with the use of highly active antiretroviral therapy, HCV infection has become a significant cause of morbidity and mortality in coinfected patients. As a result, there has been increasing attention to adequate assessment of HCV infection during the last several years. Unlike liver enzymes and HCV RNA levels, which can fluctuate widely and do not correlate with the severity of disease, liver biopsy has become the cornerstone in the evaluation of chronic HCV infection. However, there remain important questions and controversies related to adequately determining the histological severity of liver disease and the role of liver biopsy in HIV-HCV-coinfected patients.