Accurate staging of liver fibrosis remains a major challenge in chronic viral hepatitis and other liver diseases. Although liver biopsy has long been considered the reference standard, its limitations—including sampling error, inter- and intraobserver variability, invasiveness, cost, and safety concerns—have prompted the development of non-invasive alternatives. Currently, both serological biomarkers and physical methods demonstrate acceptable diagnostic performance and are widely incorporated into routine clinical practice for fibrosis assessment in viral hepatitis. A meta-analysis of serum biomarker scores like FibroTest in 6,378 subjects (including 3,501 with HCV) reported an AUROC of 0.84 (95% CI 0.83–0.86) for significant fibrosis. Similarly, for transient elastography (TE), a meta-analysis of 50 studies showed AUROCs of 0.84 for significant fibrosis and 0.94 for cirrhosis in HCV patients. This review summarizes current evidence on liver fibrosis staging in chronic hepatitis B (CHB) and chronic hepatitis C (CHC), with particular emphasis on non-invasive serological and imaging-based methods. Additionally, a key unresolved issue is discussed: the assessment of liver fibrosis following hepatitis C virus (HCV) cure, where non-invasive tests may overestimate regression due to reduced inflammation, as evidenced by studies showing persistent stiffness despite histological improvements.

liver fibrosis, chronic hepatitis, hepatitis B, hepatitis C, non-invasive tests, meta-analysis, sustained virological response

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