Nearly One Third of Asian Adults with Treatment Naïve Chronic Hepatitis B Virus (HBV) Infection with Elevated HBV DNA and Normal Alanine Aminotransferase Have Significant Hepatic Fibrosis
AASLD LiverLearning®. Wong R. Nov 14, 2016; 144721
Topic: Epidemiology/Prevention/Control
Dr. Robert Wong
Dr. Robert Wong
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TITLE: Nearly One Third of Asian Adults with Treatment Naïve Chronic Hepatitis B Virus (HBV) Infection with Elevated HBV DNA and Normal Alanine Aminotransferase Have Significant Hepatic Fibrosis

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Background: Significant histologic fibrosis may exist despite normal alanine aminotransferase (ALT) in chronic hepatitis B virus (HBV). While liver biopsy is gold standard, non-invasive measures of hepatic fibrosis may improve and guide HBV therapy in patients not meeting eligibility based on HBV DNA and ALT.
Aim: To evaluate the prevalence of fibrosis among treatment naïve chronic HBV patients with elevated HBV DNA and normal ALT using serologic testing, liver imaging, and elastography methods and the correlation between these non-invasive measures of fibrosis.
Methods: From June 2015-March 2016, we prospectively enrolled consecutive treatment naïve non-cirrhotic Asian chronic HBV adults (men > 40 years, women > 50 years) with elevated HBV DNA and normal ALT at a community-based gastroenterology clinic. Hepatic fibrosis was assessed using serologic data (FIB-4, APRI, Fibrotest), imaging data (spleen size, main portal vein diameter), and supersonic (shearwave) elastography data using 8.7 kPa cutoff to define F2 fibrosis. Correlations between these tests were analyzed with Pearson’s correlation coefficient.
Results: Among 105 patients (51.4% male, mean age 54.7 (SD 10.8), mean BMI 23.3 (SD 2.9), mean platelets 221.8 x 103/mL (SD 45.5), 5.7% diabetes, 22.9% dyslipidemia, mean FIB-4 1.3 (SD 0.5), mean APRI 0.3 (SD 0.1), 91.7% had F0-F1, 8.3% had F2-F3, no patients had F4 based on Fibrotest. With elastography, 72.4% had F0-F1, 26.7% had F2-F3, and 1.0% had F4. Moderate correlation was observed between FIB-4 and APRI (r(103)=0.648, p<0.001), weak correlations were observed between elastography and Fibrotest, elastography and FIB-4, elastography and APRI, Fibrotest and FIB-4, Fibrotest and APRI (Table). When stratified by sex, these serologic and elastography methods to assess fibrosis demonstrated better correlation in women compared to men (Table).
Conclusion: Among treatment naïve Asian adults with chronic HBV with elevated HBV DNA and normal ALT, 8.3% and 27.6% of patients had >F2 fibrosis based on Fibrotest and elastography, respectively. While there was weak correlation between elastography and serologic markers of fibrosis, accurate staging of hepatic fibrosis would be improved with combination of tests including indirect tests, imaging, and elastography.
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