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Keywords:

  • chronic viral hepatitis;
  • fibrosis area;
  • hepatic stellate cell;
  • perisinusoidal fibrosis;
  • quantitative morphometry

Abstract

Background

Liver fibrosis, now assessed by liver biopsy or using non-invasive methods, might be different in chronic hepatitis B (CHB) and chronic hepatitis C (CHC).

Aim

To compare histological amount and pattern of fibrosis in CHB and CHC.

Methods

Sixty CHB and sixty CHC biopsies from naïve patients, standardized for the spectrum of Metavir fibrosis stages, were analysed for (1) semi-quantitative Metavir activity, steatosis, perisinusoidal fibrosis, alpha-smooth muscle actin immunoreactivity, (2) quantitative morphometry of total and perisinusoidal fibrosis ratio (FR and PFR).

Results

Biopsy quality, activity, steatosis, Fibrotest® values were not different between the two groups. Correlation between FR and fibrosis stage was stronger in CHB (r = 0.90) than CHC (r = 0.81). Mean FR was 1.5-fold higher in CHC than CHB for early fibrosis stages (F ≤ 2, P = 0.001), with higher PFR in CHC for F0 (P = 0.001), F1 (P = 0.08) and F2 (P = 0.004). Hepatic stellate cell activation index was also higher in CHC than in CHB (P = 0.007). Diagnosis performance of FR for significant fibrosis was not statistically different in CHB than CHC (AUROC 0.92 and 0.87 respectively), but cut-offs optimizing sensitivity and specificity were higher in CHC and their extrapolation to CHB led to 10% decrease in sensitivity. In F ≤ 2 patients, correlation between FR and Fibrotest® was only significant in CHC.

Conclusions

As compared to CHB, amount of fibrosis is greater in CHC for F ≤ 2 patients, mainly because of higher perisinusoidal fibrosis. These data illustrate difficulty to assess early fibrosis stages by non-invasive methods, and support the need for specific cut-offs in CHB.