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Liver fibrosis progression is uncommon in patients with inactive chronic hepatitis B : A prospective cohort study with paired transient elastography examination
Author(s) -
Wong Grace LaiHung,
Chan Henry LikYuen,
Yu Zhuo,
Chan HoiYun,
Tse ChiHang,
Wong Vincent WaiSun
Publication year - 2013
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.12327
Subject(s) - medicine , transient elastography , liver fibrosis , prospective cohort study , fibrosis , cohort , gastroenterology , chronic hepatitis , pathology , immunology , virus
Abstract Background and Aims The E uropean A ssociation for the S tudy of the L iver ( EASL ) defines the inactive hepatitis B virus ( HBV ) carrier state based on HBV DNA and alanine aminotransferase ( ALT ) levels. This study aimed to evaluate the risk of disease progression in such patients. Methods Three hundred sixty‐one patients negative for hepatitis B e antigen ( HBeAg ) with HBV DNA levels < 20 000  IU /mL and normal ALT and without advanced fibrosis at baseline underwent liver stiffness measurement ( LSM ) by transient elastography between 2006 and 2008 and again between 2010 and 2012. Liver fibrosis progression was defined as an increase in LSM by 30% or more at the second assessment to levels suggestive of advanced fibrosis. Results At baseline, the mean age was 48 ± 11 years and 51% were males; ALT level was 28 ± 11  IU /L , HBV DNA level was 2.7 ± 1.0 log 10   IU / m L , and LSM was 5.4 ± 1.5  kPa . After an interval of 44 ± 7 months, liver fibrosis progression was observed in 10 (2.8%) patients, and 49 (13.6%) started antiviral therapy. Gender, age, and levels of ALT , HBV DNA , and HBsAg were shown not to be associated with liver fibrosis progression. Among 244 patients with baseline HBV DNA  < 2000  IU / m L , 2.9% had liver fibrosis progression, 8.2% started antiviral therapy, and 4.1% had HBV DNA  ≥ 20 000  IU / m L during follow‐up. Corresponding figures in 117 patients with baseline HBV DNA levels of 2000–20 000  IU / m L were 2.6%, 24.8%, and 7.7%, respectively ( P  = 1.0, < 0.001 and = 0.21 respectively). Conclusions Liver fibrosis progression within 3–4 years is rare in HBeAg ‐negative patients with HBV DNA  <20 000  IU / m L and normal ALT , but a significant proportion of patients develop treatment indications during follow‐up. The study supports the EASL 's definition of inactive carriers and its recommendation of regular monitoring.

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