title: Transient elastography, APRI, and ultrasound have minimal utility in chronic low-replicative hepatitis B infection.
abstract: OBJECTIVE
  Chronic hepatitis B (CHB) is a significant cause of morbidity and mortality. E-antigen-negative CHB patients, with low liver enzymes and viremia, generally fare better. We determined the proportion of chronic low-replicative hepatitis B patients not meeting guideline-based antiviral therapy criteria nonetheless requiring treatment and increased hepatocellular carcinoma and varices surveillance based on transient elastography (TE), aspartate aminotransferase-to-platelet ratio index (APRI), and/or ultrasound (US) findings.
  
  
  METHODS
  The Ottawa Hospital Viral Hepatitis Database was utilized. Included CHB patients were observed from January 2011 to April 2013, who were at least 18 years of age, e-antigen negative, with hepatitis B virus (HBV) DNA levels below 20,000 IU/ml, normal liver enzymes (alanine transaminase <64 U/l), and normal synthetic function. Patients with other liver diseases, HIV, or HBV antiviral use were excluded. TE and US results were recorded and APRI was calculated.
  
  
  RESULTS
  A total of 264 patients met the eligibility criteria and 79 underwent TE. The median age was 41 years (quartiles: 37, 49); 53% were male patients and 95% were immigrants. Races included 47% Southeast Asians, 37% Black, and 11% White. Mean alanine transaminase and aspartate aminotransferase were 34 U/l (SD 13) and 21 U/l (SD 7), respectively. The mean HBV DNA level was 2.15×10 IU/ml. The mean TE score was 4.5 kPa (SD 1.1). One patient had F2 fibrosis by TE. All others were F0-F1. The mean APRI was 0.30 (SD 0.20) with no values greater than 1.5.
  
  
  CONCLUSIONS
  No patients were identified with advanced fibrosis by TE, APRI, or US meriting HBV antiviral therapy and/or enhanced screening. TE and US have minimal apparent utility in this specific population.
authors: Ottawa Hospital Research Institute, The Ottawa Hospital and Regional Hepatitis Program, University of Ottawa, Ottawa, Ontario, Canada.
authors: Angela
authors: A
authors: Assal
authors: David
authors: D
authors: Mackie
authors: Curtis L
authors: CL
authors: Cooper
mesh_terms: D000328:Adult; D001219:Aspartate Aminotransferases / Q000097:blood; D001706:Biopsy; D004796:Clinical Enzyme Tests; D004279:DNA, Viral / Q000097:blood; D054459:Elasticity Imaging Techniques; D005260:Female; D006515:Hepatitis B virus / Q000302:isolation & purification / Q000502:physiology*; D019694:Hepatitis B, Chronic / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000821:virology; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000821:virology; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011159:Population Surveillance / Q000379:methods; D011446:Prospective Studies; D019564:Unnecessary Procedures; D019562:Viral Load; D014779:Virus Replication
chemical_list: D004279:DNA, Viral; D001219:Aspartate Aminotransferases