Abstract
Background: Liver stiffness measurement (LSM) with transient elastography can accurately predict advanced liver fibrosis in treatment-naive chronic hepatitis B (CHB) patients. Its performance to monitor the changes in the severity of liver fibrosis in CHB patients on antiviral treatment is uncertain. Methods: We prospectively studied CHB patients undergoing paired liver biopsy and transient elastography before and at week 48 of antiviral treatment. Based on our previously reported algorithm, advanced liver fibrosis (Metavir F3–4) was excluded by LSM≤6.0 kPa and ≤7.5 kPa while advanced fibrosis was diagnosed by LSM >9.0 kPa and >12.0 kPa for patients with normal and elevated (>1–5 times upper limit of normal) ALT, respectively [Chan et al., J Virol Hepat 2008]. Results: Seventy-one patients (47 on clevudine; 24 on adefovir) were studied. The median change of Metavir fibrosis stage from baseline to week 48 was 0 (range −1 to 1). Seventeen and 11 patients had regression and progression of histologic fibrosis, respectively. The median ALT decreased from 99 IU/l to 33 IU/l (P 10% had decreased, unchanged and increased histologic stages, respectively. Conclusions: LSM could predict advanced fibrosis during antiviral therapy according to the ALT-based algorithm. Decrease in absolute LSM value, which could reflect the effect of ALT normalization, was unreliable to indicate regression of liver fibrosis.
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