Assessment of hepatic fibrosis and necroinflammation among inactive HBsAg carriers in Egypt.
INTRODUCTION. The inactive hepatitis B surface antigen (HBsAg) carrier state is usually characterized by minimal or absent liver pathology. However, in developing countries, owing to the very early age of infection with hepatitis B virus (HBV), this state is reached after a very prolonged immune tolerant and immune reactive phase, during which considerable liver damage may have occurred. The extent of liver damage in inactive HBsAg carriers has not been thoroughly assessed in developing countries. We thus sought to characterize liver pathology among Egyptian inactive HBsAg carriers.


METHODS
Liver biopsy was conducted on 30 inactive HBsAg carriers [positive for HBsAg; negative for HBeAg; positive for antibody to HBeAg (anti-HBe); HBV-DNA levels < 2,000 IU/mL; persistently normal serum alanine aminotransferase (ALT)]. Liver histopathology was assessed according to the Ishak scoring system.


RESULTS
Among the studied carriers, 6.7% had no hepatic fibrosis, 73.3% had stage 1 fibrosis, and 20% had stage 2 fibrosis. The majority (80%) of carriers had minimal hepatic necroinflammation (grades 2-4), while 20% had mild hepatic necroinflammation (grade 5). All patients with stage 2 fibrosis were males, while no gender predilection was observed for necroinflammation. Age, ALT and HBV-DNA levels did not differ significantly according to fibrosis or necroinflammatory scores.


CONCLUSIONS
Our study findings do not support the presence of significant hepatic fibrosis or necroinflammation among Egyptian inactive HBsAg carriers. However, follow-up studies on these carriers may be required to monitor any further pathological progress of the disease.
Department of Gastroenterology and Hepatology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Amr Abdelkader
AA
Fateen
Rasha Youssef
RY
Shahin
Mohamed Nazmy
MN
Farres
Mai Ahmed
MA
Eldeeb
Hanaa Ahmed
HA
Amer
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D004279:DNA, Viral / Q000097:blood; D003906:Developing Countries; D018450:Disease Progression; D004534:Egypt; D005260:Female; D006509:Hepatitis B / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology*; D006801:Humans; D008099:Liver / Q000473:pathology* / Q000821:virology; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D008297:Male; D012720:Severity of Illness Index; D019562:Viral Load; D055815:Young Adult
D015415:Biomarkers; D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D000410:Alanine Transaminase