Abstract
Background: Accurate assessment of hepatic fibrosis in patients with chronic HBeAg-negative Hepatitis B is of crucial importance not only to predict the long-term clinical course, but also to evaluate antiviral therapy indication. The aim of this study was to prospectively assess the utility of point shear wave elastography (pSWE) for longitudinal non-invasive fibrosis assessment in a large cohort of untreated patients with chronic HBeAg-negative hepatitis B virus (HBV) infection. Methods: 407 consecutive patients with HBeAg-negative HBV infection who underwent pSWE, transient elastography (TE) as well as laboratory fibrosis markers, including fibrosis index based on four factors (FIB-4), aspartate to platelet ratio index (APRI) and FibroTest, on the same day were prospectively followed up for six years. Patients were classified into one of the three groups: inactive carriers (IC; HBV-DNA <2000 IU/mL and ALT <40 U/L); grey zone group 1 (GZ-1; HBV DNA <2000 IU/mL and ALT >40 U/L); grey zone group 2 (GZ-2; HBV-DNA >2000 IU/mL and ALT <40 U/L). Results: pSWE results were significantly correlated with TE (r = 0.29, p < 0.001) and APRI (r = 0.17; p = 0.005). Median pSWE values did not differ between IC, GZ-1 and GZ-2 patients (p = 0.82, p = 0.17, p = 0.34). During six years of follow-up, median pSWE and TE values did not differ significantly over time (TE: p = 0.27; pSWE: p = 0.05). Conclusion: Our data indicate that pSWE could be useful for non-invasive fibrosis assessment and follow-up in patients with HBeAg-negative chronic HBV infection.
Highlights
Chronic hepatitis B virus infection (HBV) is an important global public health issue with considerable morbidity and mortality [1,2].HBeAg-negative chronic HBV infection, previously termed inactive carrier (IC) state, has become the predominant type of chronic HBV worldwide [3]
Some patients with HBeAg-negative chronic hepatitis B (CHB) may present with major fluctuations of viral replication and ALT that may be associated with active necroinflammation or fibrosis with temporary remissions that mimic inactive infection and make it difficult to differentiate from IC [4,5]
Several studies have proven its clinical application through comparisons with other non-invasive fibrosis assessments and the results show that it is a competent diagnostic tool with a higher diagnostic accuracy for advanced fibrosis (F3–F4) than for low-grade fibrosis (F1–F2) [12]
Summary
Chronic hepatitis B virus infection (HBV) is an important global public health issue with considerable morbidity and mortality [1,2].HBeAg-negative chronic HBV infection, previously termed inactive carrier (IC) state, has become the predominant type of chronic HBV worldwide [3]. Some patients with HBeAg-negative chronic hepatitis B (CHB) may present with major fluctuations of viral replication and ALT that may be associated with active necroinflammation or fibrosis with temporary remissions that mimic inactive infection and make it difficult to differentiate from IC [4,5]. Antiviral treatment is generally indicated in patients with persistent or recurrent ALT elevations above the upper limit of normal (ULN, 40 U/L), in association with HBV DNA levels above 2000 IU/mL and/or liver histology showing moderate necroinflammation or fibrosis [8] For this reason, most clinical practice guidelines still recommend histologic assessment for staging of liver fibrosis and for determining treatment candidacy, in particular when hepatitis B virus (HBV) DNA and/or alanine aminotransferase (ALT) levels are near the threshold for starting therapy [8,9,10]. Conclusion: Our data indicate that pSWE could be useful for non-invasive fibrosis assessment and follow-up in patients with HBeAg-negative chronic HBV infection
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