Until recently, liver biopsy (LB) examination was the only way of evaluating liver fibrosis. However, LB examination is invasive and painful, and can have life-threatening complications. The poor acceptability of LB examination can lead to treatment delays, and LB examination is difficult to repeat in poorly symptomatic subjects. The accuracy of LB examination for assessing fibrosis also has been questioned because of sampling errors and intra- and interobserver variability that may lead to over- or under staging of fibrosis. There is thus a need for accurate noninvasive methods of measuring the degree of liver fibrosis. Proposed approaches include physical examination, routine biochemical and hematologic tests, surrogate serum fibrosis markers have been used.