Grace L-H Wong has served as an advisory committee member for Otsuka and as a speaker for Echosens.
Liver fibrosis progression is uncommon in patients with inactive chronic hepatitis B: A prospective cohort study with paired transient elastography examination
Version of Record online: 22 NOV 2013
© 2013 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd
Journal of Gastroenterology and Hepatology
Volume 28, Issue 12, pages 1842–1848, December 2013
How to Cite
Wong, G. L.-H., Chan, H. L.-Y., Yu, Z., Chan, H.-Y., Tse, C.-H. and Wong, V. W.-S. (2013), Liver fibrosis progression is uncommon in patients with inactive chronic hepatitis B: A prospective cohort study with paired transient elastography examination. Journal of Gastroenterology and Hepatology, 28: 1842–1848. doi: 10.1111/jgh.12327
Henry L-Y Chan is a consultant for Abbott, Bristol-Myers Squibb, Gilead, Merck, FuRui, Novartis, and Roche, has received honoraria for lectures from Abbott, Bristol-Myers Squibb, Echosens, Gilead, Glaxo-Smith-Kline, Merck, Novartis, and Roche, and has received an unrestricted grant from Roche for hepatitis B research.
Vincent W-S Wong has served as an advisory committee member for Roche, Novartis, Gilead, and Otsuka. He has also served as a speaker for Bristol-Myers Squibb, Roche, Novartis, Abbott Diagnostics, and Echosens.
The other authors declare that they have no competing interests.
- Issue online: 22 NOV 2013
- Version of Record online: 22 NOV 2013
- Accepted manuscript online: 5 JUL 2013 06:29AM EST
- Manuscript Accepted: 21 JUN 2013
- Research Fund for the Control of Infectious Diseases (RFCID). Grant Number: 11100372
- alanine aminotransferase;
- antiviral therapy;
- HBV DNA;
- liver stiffness measurement
Background and Aims
The European Association for the Study of the Liver (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.
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.
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 log10 IU/mL, 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/mL, 2.9% had liver fibrosis progression, 8.2% started antiviral therapy, and 4.1% had HBV DNA ≥ 20 000 IU/mL during follow-up. Corresponding figures in 117 patients with baseline HBV DNA levels of 2000–20 000 IU/mL were 2.6%, 24.8%, and 7.7%, respectively (P = 1.0, < 0.001 and = 0.21 respectively).
Liver fibrosis progression within 3–4 years is rare in HBeAg-negative patients with HBV DNA <20 000 IU/mL 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.