Liver biopsy has classically been considered the gold standard to evaluate the degree of fibrosis, since it allows direct measurement of this entity. However, this technique carries an inherent risk of complications and observer variability and technical limitations can provoke sampling errors, all of which has prompted the search for alternative, noninvasive methods. The use of routine clinical laboratory tests has been investigated and various indexes that combine indirect serological markers have been developed and validated. These indexes are useful, low-cost, noninvasive tests to detect significant fibrosis or cirrhosis. Direct serological markers are those that reflect changes in the composition of the extracellular matrix. Several studies have analyzed the utility of these markers (either individually or combined with other direct and indirect markers) in the detection of the severity and progression of liver fibrosis and in the follow-up of changes related to antiviral therapy. In the last few years, imaging tests based on the measurement of liver stiffness, such as FibroScan or acoustic radiation force impulse (ARFI), have been found to be rapid and reproducible methods to evaluate liver fibrosis. Recently, the results obtained by combining distinct serological markers and imaging techniques have shown a higher diagnostic yield and this strategy seems promising. The present article reviews the most widely discussed noninvasive markers, the most recent alternatives, and the perspectives for their use in clinical practice.