Fibrosis Progression in Untreated Hepatitis B Patients with Normal ALT by Transient Elastography

Abstract

Introduction: Untreated hepatitis B virus (HBV) may lead to progression of liver fibrosis. The aim of this study is to assess fibrosis progression, as determined by transient elastography, in patients who are not on antiviral therapy as compared to patients who were on therapy. Methods: A retrospective chart review was conducted from a single center database of patients with HBV. Staging liver biopsy results from 2000-2015 were compared to staging done by transient elastography performed between the years 2013-2015. Patients were divided into two groups: those that had viral suppression (< 20 copies/mL) on treatment and those who were not on treatment that had ongoing viral replication. Student's matched sample t-test was used to determine the difference between transient elastography fibrosis staging and the initial staging by biopsy. Results: There were a total of 29 HBV patients with 15 patients that had viral suppression on antiviral treatment (5 Viread, 4 Truvada, 6 Entecavir) and 14 that were not treated. Baseline demographics can be found in Table 1. The baseline average stage of fibrosis by initial biopsy in the patients on antiviral treatment was 2.4 ± 1.6. Follow-up transient elastography scores for this group after a mean follow-up period of eight years from the initial biopsy yielded a mean stage of 2 (score of 7.5±3.4 kPa) For those patients not on treatment, the baseline average stage of fibrosis by initial biopsy was 1.3±0.47. The follow-up transient elastography scores for this group after a mean follow-up period of eight years as well from the initial biopsy yielded stage 3 (mean score of 10.2±3.2 kPa). The difference between elastography scores between these two groups was found to be significant (p < 0.005).Table 1Conclusion: Elastography test scores accurately depicted a stability in overall fibrosis in patients who achieved viral suppression for hepatitis B. Our study shows that fibrosis scores increased in patients who were not on antiviral treatment. The utility of gauging fibrosis by elastography may help determine disease severity without the need for invasive procedures such as liver biopsy. Future prospective studies are needed to further examine the use and utility of elastography scores in hepatitis B patients.