Transient elastography and biomarkers for liver fibrosis assessment and follow-up of inactive hepatitis B carriers

Authors

  • L. Castéra,

    1. Service d’Hépato-Gastroentérologie, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire (C.H.U.) Bordeaux, Pessac, France.
    2. Service d’Hépato-Gastroentérologie, Hôpital St-André, C.H.U. Bordeaux, Bordeaux, France.
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  • P.-H. Bernard,

    1. Service d’Hépato-Gastroentérologie, Hôpital St-André, C.H.U. Bordeaux, Bordeaux, France.
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  • B. Le Bail,

    1. Service d’Anatomo-Pathologie, Hôpital Pellegrin, C.H.U. Bordeaux, Bordeaux, France.
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  • J. Foucher,

    1. Service d’Hépato-Gastroentérologie, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire (C.H.U.) Bordeaux, Pessac, France.
    2. Service d’Hépato-Gastroentérologie, Hôpital St-André, C.H.U. Bordeaux, Bordeaux, France.
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  • P. Trimoulet,

    1. Laboratoire de Virologie, Hôpital Pellegrin, C.H.U. Bordeaux, Bordeaux, France.
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  • W. Merrouche,

    1. Service d’Hépato-Gastroentérologie, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire (C.H.U.) Bordeaux, Pessac, France.
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  • P. Couzigou,

    1. Service d’Hépato-Gastroentérologie, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire (C.H.U.) Bordeaux, Pessac, France.
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  • V. de Lédinghen

    1. Service d’Hépato-Gastroentérologie, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire (C.H.U.) Bordeaux, Pessac, France.
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Dr L. Castéra, Service d’Hépatologie, Hôpital Beaujon, AP-HP, Clichy, Université Denis Diderot Paris VII, France.
E-mail: laurent.castera@bjn.aphp.fr

Summary

Background  Non invasive methods for fibrosis evaluation remain to be validated longitudinally in hepatitis B.

Aim  To evaluate longitudinally transient elastography (TE) and biomarkers for liver fibrosis assessment and follow-up of hepatitis B virus (HBV) inactive carriers.

Methods  Three hundred and twenty-nine consecutive HBeAg-negative HBV patients (201 inactive carriers) who underwent TE, Fibrotest and aspartate to platelet ratio index (APRI) the same day were studied.

Results  TE (median 4.8 vs. 6.8 kPa, P < 0.0001), Fibrotest (0.16 vs. 0.35, P < 0.0001) and APRI values (0.28 vs. 0.43, P < 0.0001) were significantly lower in inactive carriers than in the remaining patients whereas they did not differ among inactive carriers according to HBV DNA levels. In 82 inactive carriers with repeated examinations, although differences were observed among individual patients, TE values did not differ significantly over time (median intra-patient changes at end of follow-up relative to baseline: −0.2 kPa, P = 0.12). Conversely, significant fluctuations were observed for Fibrotest (+0.03, P = 0.012) and APRI (−0.01, P < 0.05). Eleven inactive carriers (5.5%) had initial elevated TE values (>7.2 kPa) confirmed during follow-up in two with significant fibrosis (F2 and F3) on liver biopsy.

Conclusion  Non-invasive tools, particularly TE, could be useful, in addition to HBV DNA and transaminase levels, for follow-up of HBV inactive carriers as well as better selection of patients who require a liver biopsy.

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