METAVIR Score F0-F1: Minimal to No Liver Fibrosis

Fibrosis Stage Classification

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, according to the European Association for the Study of the Liver (EASL) 1, 2
F2 = Moderate fibrosis (portal fibrosis with few septa), and F3 = Severe fibrosis (numerous septa without cirrhosis), as classified by the American Association for the Study of Liver Diseases (AASLD) 3
F4 = Cirrhosis, as defined by the American Association for the Study of Liver Diseases (AASLD) 4, 5, 6

F0-F1 patients are not at immediate risk for clinical decompensation and have an extremely low risk of hepatocellular carcinoma (HCC), as stated by the European Association for the Study of the Liver (EASL) 3

According to EASL guidelines, treatment for patients with F0-F1 and no severe extra-hepatic manifestations can be individualized and informed deferral is acceptable, as recommended by the European Association for the Study of the Liver (EASL) 1, 2, 7
Treatment should be prioritized regardless of F0-F1 status in patients at risk of HCV transmission, with clinically significant extra-hepatic manifestations, HIV or HBV coinfection, or debilitating fatigue, as recommended by the European Association for the Study of the Liver (EASL) 1, 2, 7

Patients with F0-F1 who achieve sustained virologic response (SVR) can be safely discharged from specialized hepatology care to general practitioner follow-up, as stated by the American Association for the Study of Liver Diseases (AASLD) 3
VCTE liver stiffness <8 kPa or FIB-4 <1.45 confirms minimal fibrosis and allows discharge, as defined by the American Association for the Study of Liver Diseases (AASLD) 3

Non-invasive serum markers and elastography can differentiate F0-F1 from significant fibrosis (F2-F4) with AUROC scores of approximately 0.8-0.87, as reported by the American Association for the Study of Liver Diseases (AASLD) 4, 5, 6

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, as warned by the European Association for the Study of the Liver (EASL) 3

In the METAVIR scoring system for liver fibrosis, a score of F1 denotes minimal fibrosis characterized by no septa or only rare thin septa in liver tissue 8.