title: The usefulness of transient elastography in the assessment of patients with HBeAg-negative chronic hepatitis B virus infection.
abstract: Histological severity is often mandatory for the management of HBeAg-negative chronic HBV patients. We evaluated the performance of transient elastography (TE) in this setting. We included 357 untreated HBeAg-negative patients with ≥ 1 reliable liver stiffness measurement (LSM-kPa) by TE: 182 inactive carriers with HBV-DNA < 2000 (n = 139) or 2000-19 999 IU/mL (n = 43) and 175 patients with chronic hepatitis B (CHB). In carriers, HBV-DNA > 2000 and/or LSM > 6.5 were considered as biopsy indications. LSMs did not differ between carriers with low and high viremia, but were lower in carriers than in patients with CHB (5.8 ± 1.7 vs 9.0 ± 5.6, P < 0.001) offering moderate differentiation between these two groups (AUROC: 0.705). LSMs did not change significantly in carriers after 16 (12-24) months. In carriers with a liver biopsy, Ishak's staging scores were similar between cased with low and high viremia but higher in cases with LSM > 6.5 than ≤ 6.5 kPa. Moderate fibrosis (stages: 2-3) was detected in 0/10 carriers with only HBV-DNA > 2000 IU/mL, 2/10 (20%) carriers with only LSM > 6.5 and 5/10 (50%) carriers with both HBV-DNA > 2000 and LSM > 6.5 (P = 0.009). In patients with CHB, LSMs correlated significantly with grading and staging scores and offered excellent accuracy for ≥ moderate, ≥ severe fibrosis or cirrhosis (AUROC ≥ 0.919-0.950). TE can be helpful for the noninvasive assessment of HBeAg-negative chronic HBV patients. In conclusion, LSMs offer excellent accuracy for fibrosis severity in HBeAg-negative patients with CHB and can identify carriers with high risk of moderate fibrosis, which may be present in up to 35% of carriers with LSM > 6.5 kPa and 50% of carriers with LSM > 6.5 kPa and HBV-DNA > 2000 IU/mL.
authors.affiliation: 2nd Department of Internal Medicine, Athens University Medical School, 'Hippokration' General Hospital of Athens, Athens, Greece.
authors.forename: G V
authors.initials: GV
authors.lastname: Papatheodoridis
authors.forename: S
authors.initials: S
authors.lastname: Manolakopoulos
authors.forename: A
authors.initials: A
authors.lastname: Margariti
authors.forename: M V
authors.initials: MV
authors.lastname: Papageorgiou
authors.forename: H
authors.initials: H
authors.lastname: Kranidioti
authors.forename: A
authors.initials: A
authors.lastname: Katoglou
authors.forename: G
authors.initials: G
authors.lastname: Kontos
authors.forename: S
authors.initials: S
authors.lastname: Adamidi
authors.forename: G
authors.initials: G
authors.lastname: Kafiri
authors.forename: M
authors.initials: M
authors.lastname: Deutsch
authors.forename: D
authors.initials: D
authors.lastname: Pectasides
mesh_terms: D000328:Adult; D000368:Aged; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006513:Hepatitis B e Antigens / Q000097:blood*; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000821:virology; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index
chemical_list: D006513:Hepatitis B e Antigens
keywords: HBV-DNA; chronic hepatitis B; elastography; inactive carriers; liver biopsy