Liver Biopsy Is Necessary To Accurately Diagnose the Severity of Chronic Hepatitis B

Abstract

Purpose: Hepatitis B (HBV) practice guidelines include viral load, HBeAg (eAg) status, Alanine aminotransferase (ALT) and histology for patient management. Little histological data exists for those with low viral load (LVL), normal ALT, and negative HBeAg since disease progression is felt to be rare. AIM: Compare histological disease in HBV patients. Methods: A cross sectional study of sequential HBV infected patients referred to our center was performed. Inclusion criteria: (1) measurable HBV DNA (Taqman Real Time PCR); (2) no co-infections; (3) immune competent; (4) no prior antiviral treatment; (5) liver biopsy. Low viral load (LVL) was defined as <105 copies/ml and high viral load (HVL) as >105 copies/ml. METAVIR scores were categorized using the following combined histological severity definitions: Normal (grade 0/stage 0); Mild (grade 1 ± stage 1); Moderate (grade 2 ± stage 2); and Severe (grade 3–4 ± stage 3–4). Patients were then categorised into 3 groups based on ALT and Viral load. Group A: normal ALT/LVL; Group B: normal ALT/HVL; Group C: abnormal ALT/HVL. Demographics, Body mass index (BMI), ethanol use and eAg status were determined. Results: 23 patients met inclusion criteria of which 11 were women and 12 men. Race:18 Asians (Vietnamese 13, Korean 1, Combodian 1, Chinese 2, Taiwanese1), Hispanic 2, African Descent 3. Age range 30–71 (mean 50). Groups: A: N = 11 (all HBeAg negative); B: N = 8; C: N = 4. Group histology results by eAg status: B: eAg+ (n = 2) 1/2 mild, 1 moderate, eAg neg. (n = 2) both severe; C: eAg+ (n = 4), ¾ severe, 1/3 moderate, eAg neg. 2/3 severe, 1/3 moderate. Significant alcohol intake in 1 Group C patient with cirrhosis, all others denied significant alcohol use. All patients below 40 years (n = 6) had mild to moderate disease. Conclusions: ALT, viral load and eAg status can be unreliable in predicting HBV disease progression. High rates of histologically worrisome disease was observed in our patients with LVL or HVL and normal ALT regardless of eAg status. Therefore, a liver biopsy should be considered in all HBV infected patients with detectable viremia, even low level viremia. These results need to be confirmed in a larger cohort.Table: Histology vs Viral Load