Changes in APRI and FIB-4 in HBeAg-negative treatment-naive chronic hepatitis B patients with significant liver histological lesions receiving 5-year entecavir therapy

Liu, Ruyu; Guo, Jiang; Lu, Yao; Zhang, Lu; Shen, Ge; Wu, Shuling; Chang, Mi Yok; Hu, Leiping; Hao, Hongxiao; Li, Minghui; Xie, Yao

doi:10.1007/s10238-019-00560-z

Cited by 15 publications

(18 citation statements)

References 25 publications

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“…This is especially remarkable, as it was initially designed to diagnose advanced fibrosis in patients with chronic virologic liver injury and not for diagnosing NAFLD or NASH [16,18]. The usage of APRI has since widened and there have been successful validations of its use in non-alcoholic chronic liver diseases [16] as well as descriptions of its usage in monitoring hepatitis B under therapy [29] or diagnosis of fibrosis in post-hepatitis C patients [30]. AASLD practice guidelines also recommend its usage in diagnosis of NAFLD and NASH in obese patients [17].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of NAFLD and fibrosis in obese patients – a comparison of histological and clinical scoring systems

et al. 2020

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Background: Non-alcoholic fatty liver disease (NAFLD) is a frequent condition in obese patients and regularly progresses to non-alcoholic steatohepatitis (NASH) and subsequent cirrhosis. Histologic evaluation is the gold standard for grading and staging, but invasive biopsies are associated with obvious risks. The aim of this study was to evaluate different non-invasive tools for screening of NAFLD and fibrosis in obese patients. Methods: In a prospective cohort study liver specimens of 141 patients were taken during bariatric surgery. Serological parameters and clinical data were collected and the following scores calculated: NASH clinical scoring system (NCS), aspartate aminotransferase to platelet ratio index (APRI), FIB-4 as well as NAFLD fibrosis score (NFS). Liver function capacity was measured preoperatively by LiMAx test (enzymatic capacity of cytochrome P450 1A2). Intraoperative liver biopsies were classified using NAFLD activity score (NAS) and steatosis, activity and fibrosis (SAF) score. Results: APRI was able to differentiate between not NASH and definite NASH with a sensitivity of 74% and specificity of 67% (AUROC 0.76). LiMAx and NCS also showed significant differences between not NASH and definite NASH. No significant differences were found for NFS and Fib-4. APRI had a high sensitivity (83%) and specificity (76%) in distinguishing fibrosis from no fibrosis (AUROC = 0.81). NCS and Fib-4 also revealed high AUROCs (0.85 and 0.67), whereas LiMAx and NFS did not show statistically significant differences between fibrosis stages. Out of the patients with borderline NASH in the histologic NAS score, 48% were classified as NASH by SAF score. Conclusions: APRI allows screening of NAFLD as well as fibrosis in obese patients. This score is easy to calculate and affordable, while conveniently only using routine clinical parameters. Using the NAS histologic scoring system bears the risk of underdiagnosing NASH in comparison to SAF score.

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Section: Discussionmentioning

confidence: 99%

Evaluation of NAFLD and fibrosis in obese patients – a comparison of histological and clinical scoring systems

et al. 2020

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“…Liu et al investigated the changes in the APRI score and FIB-4 index in 303 HBeAg-negative CHB patients receiving ETV. 29 Compared with baseline values, the APRI score decreased significantly after 3 years of AVT in patients with cirrhosis (F4), while the APRI score decreased significantly 1 year after AVT in patients with F2 and F3. In addition, the FIB-4 index also decreased significantly in F2, F3, and F4 patients after 1, 3, and 5 years after AVT.…”

Section: Discussionmentioning

confidence: 85%

“…Third, the APRI score and the FIB-4 index are acknowledged to have moderate accuracy for assessing the degree of liver fibrosis. [15][16][17] Although several previous studies have shown the significant reduction in these two markers during AVT, 26,29,31,36 it has not been well-validated whether they can assess the dynamic change in fibrotic burden during AVT. Accordingly, further validation studies using more accurate tools such as transient elastography or magnetic resonance elastography might be required.…”

Section: Discussionmentioning

confidence: 99%

Long‐term effects of entecavir and tenofovir treatment on the fibrotic burden in patients with chronic hepatitis B

Chon

Kim

Seo

et al. 2021

J of Gastro and Hepatol

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Background and Aim: Antiviral therapy (AVT) induces fibrosis regression in patients with chronic hepatitis B. We investigated long-term effects of entecavir (ETV) versus tenofovir (TDF) on fibrotic burden. Methods: Treatment-naïve chronic hepatitis B patients who had begun ETV or TDF were recruited from four tertiary hospitals. The aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis index based on four factors (FIB-4) were used to determine fibrotic burden. Results: In the entire population (n = 3277), although patients treated with ETV had higher baseline APRI (1.71 vs 1.07, P < 0.001) and FIB-4 (3.60 vs 2.80, P < 0.001) than those treated with TDF, significant fibrosis regression was identified during 6 years of AVT in both ETV (APRI, mean 1.71 → 0.48, P < 0.001; FIB-4, mean 3.60 → 2.21, P < 0.001) and TDF groups (APRI, mean 1.07 → 0.43, P < 0.001; FIB-4, mean 2.80 → 2.19, P < 0.001). In patients without cirrhosis (n = 2366), baseline APRI was significantly higher in ETV group than in TDF group (1.72 vs 0.97, P < 0.001); however, they became similar after 6 months. Similarly, baseline FIB-4 was significantly higher in ETV group than in TDF group (3.25 vs 2.35, P < 0.001), but became similar from 4 to 6 years. In patients with cirrhosis (n = 911), baseline APRI (1.70 vs 1.34, P < 0.001) and FIB-4 (4.62 vs 3.91, P = 0.005) were higher in ETV group than in TDF, however, both parameters became statistically similar from 6 months to 6 years. Conclusion: Significant regression of APRI and FIB-4 was observed during long-term ETV and TDF treatment. Despite higher baseline fibrotic burden in ETV group, fibrotic burden between the groups eventually converged through significant fibrosis regression after 1 to 4 years of AVT.

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“…Finally, no liver biopsy or liver stiffness results were obtained before HAART; therefore, the APRI and platelets were used as indicators in this study. 30,31 In conclusion, this study investigated the differences in quasispecies complexity and diversity of the HBV pre-S region between HBV mono-infected and HIV/HBV coinfected patients as well as the correlation of quasispecies indices with immune cell counts, liver enzymes, and inflammatory cytokines. Low quasispecies complexity and diversity were found in HIV/HBV co-infected patients, and significant correlations were observed between all quasispecies indices and sCD163 and IL-18.…”

Section: Discussionmentioning

confidence: 99%

<p>Comparison and Correlation of Genetic Variability of the HBV Pre-S Region in HIV/HBV Co-Infected Patients: Quasispecies Perspective</p>

Nie

Deng

Lan

et al. 2020

IDR

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Background: Human immunodeficiency virus (HIV)/hepatitis B virus (HBV) co-infection can accelerate HBV-induced liver disease. A previous study showed that variation in the HBV pre-S region and quasispecies heterogeneity (Sn, mean genetic distance, dS, dN, and dS/dN) are both related to HBV-induced terminal liver disease in HBV mono-infection. Currently, data are lacking on quasispecies variation of the HBV pre-S region in HIV/HBV co-infection. Investigating the quasispecies variation of the HBV pre-S region and its related factors in HIV/HBV co-infection will help to better explore the pathogenic mechanism of HIV/HBV co-infection. Methods: According to the HIV antibody results obtained before treatment, chronic HBVinfected patients were divided into HIV/HBV co-infected and HBV mono-infected groups. The clinical characteristics of all patients were collected, and DNA was extracted from the serum. The HBV pre-S region was amplified by nested PCR and was further TA cloned. BioEdit software 7.0 was used for sequence alignment with reference to the standard sequence of the matched HBV genotype. We used 1:1 propensity score matching (PSM) to control for baseline confounding factors between the two groups. Results: After 1:1 PSM, we identified 100 patients with similar propensities: 50 HIV/HBV co-infected patients and 50 HBV mono-infected patients. HBV quasispecies indices were lower in the HIV/HBV co-infected group than those in the HBV mono-infected group. A significant correlation was observed between all quasispecies indices and soluble cluster of differentiation 163 (sCD163) and interleukin-18 (IL-18) in the HIV/HBV co-infected group; however, this phenomenon was not found in the HBV mono-infected group. Conclusion: Combined HIV infection reduces quasispecies heterogeneity in the HBV pre-S region, and the quasispecies heterogeneity is related to the sCD163 and IL-18 levels.

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Changes in APRI and FIB-4 in HBeAg-negative treatment-naive chronic hepatitis B patients with significant liver histological lesions receiving 5-year entecavir therapy

Cited by 15 publications

References 25 publications

Evaluation of NAFLD and fibrosis in obese patients – a comparison of histological and clinical scoring systems

Evaluation of NAFLD and fibrosis in obese patients – a comparison of histological and clinical scoring systems

Long‐term effects of entecavir and tenofovir treatment on the fibrotic burden in patients with chronic hepatitis B

<p>Comparison and Correlation of Genetic Variability of the HBV Pre-S Region in HIV/HBV Co-Infected Patients: Quasispecies Perspective</p>

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