Liver Fibrosis in the Natural Course of Chronic Hepatitis B Viral Infection: A Systematic Review with Meta-Analysis

Lin, Mei-Hong; Li, Haiqiong; Zhu, Lin; Su, Haiying; Peng, Lishan; Wang, Chuang-Yuan; He, Cai-Ping; Liang, Xieer; Wang, Yan

doi:10.1007/s10620-021-07009-y

Cited by 12 publications

(7 citation statements)

References 49 publications

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“…In addition, the definition of immune tolerant phase and inactive CHB was based on a single‐time test at enrolment in our study and some of them be the regression of flare in patients with an immune‐active infection which might also lead to a higher proportion of significant fibrosis. Consistent with our study, a meta‐analysis enroled 9377 CHB patients with liver biopsy also showed that the prevalence of non‐fibrosis in the immune‐tolerant and inactive patients were only 31.2% and 32.4%, while about 20% of patients had significant fibrosis in both phases 16 . Although current guidelines recommend that antiviral therapy is not urgently needed for these patients, 3,10,14 our results as well as the previous study suggest that liver biopsy should be considered to assess the liver histology in selected immune‐tolerant and inactive patients 15 .…”

Section: Discussionsupporting

confidence: 90%

“…HBeAg‐positive and HBeAg‐negative immune‐active patients often have active diseases. As expected, the majority of immune‐active patients had significant histological disease, which is similar to the previous studies 16 . Of note, nearly half of immune‐tolerant CHB patients also presented significant histological disease, which was higher compared to a previous report 17 .…”

Section: Discussionsupporting

confidence: 89%

“…As expected, the majority of immune-active patients had significant histological disease, which is similar to the previous studies. 16 Of note, nearly half of immune-tolerant CHB patients also presented significant histological disease, which was higher compared to a previous report. 17 However, the median HBV DNA level (9.1 log 10 IU/ml) in the previous study was higher than that of our study (7.6 log 10 IU/ml).…”

Section: Discussioncontrasting

confidence: 54%

“…CHB patients with liver biopsy also showed that the prevalence of non-fibrosis in the immune-tolerant and inactive patients were only 31.2% and 32.4%, while about 20% of patients had significant fibrosis in both phases. 16 Although current guidelines recommend that antiviral therapy is not urgently needed for these patients, 3,10,14 our results as well as the previous study suggest that liver biopsy should be considered to assess the liver histology in selected immunetolerant and inactive patients. 15 Our results also support the recommendation of liver biopsy for HBeAg-positive patients over 30…”

Section: Discussionmentioning

confidence: 58%

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Significant histological disease of patients with chronic hepatitis B virus infection in the grey zone

Wang

Yan

Zhu

et al. 2022

Aliment Pharmacol Ther

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Summary Background Many patients with chronic hepatitis B (CHB) do not meet the definitions of the traditional natural phases and are classified as being in the grey zone (GZ). Aims To investigate liver histology, and to establish a management strategy for patients with CHB in the GZ. Methods This study included 1043 patients with CHB who underwent liver biopsy. Phases of natural history were determined according to the AASLD 2018 hepatitis B guidance. CHB patients in the GZ were divided into HBeAg‐positive, normal ALT and HBV DNA ≤106 IU/ml (GZ‐A); HBeAg‐positive, elevated ALT and HBV DNA ≤2 × 104 IU/ml (GZ‐B); HBeAg‐negative, normal ALT and HBV DNA ≥2 × 103 IU/ml (GZ‐C) and HBeAg‐negative, elevated ALT and HBV DNA ≤2 × 103 IU/ml (GZ‐D). Significant histological disease was defined as liver inflammation ≥G2 and/or liver fibrosis ≥S2. Results Two hundred and forty two (23.2%) patients were in the GZ. Approximately 72.7% had significant histological disease. HBeAg‐positive GZ CHB patients had a higher proportion of significant histological disease than HBeAg‐negative GZ patients (91.1% vs. 68.5%, p = 0.002). GZ‐D (42.6%) was the dominant category, followed by GZ‐C (38.8%), GZ‐A (10.3%) and GZ‐B (8.3%). The highest proportion of significant histological disease was observed patients in GZ‐B (100.0%), followed by GZ‐A (84.0%), GZ‐D (69.9%) and GZ‐C (67.0%). Prothrombin time (PT) was an independent risk factor of significant histological disease in the HBeAg‐negative GZ. Conclusions Over 70% of GZ CHB patients had significant histological disease. We recommend antiviral treatment for HBeAg‐positive and HBeAg‐negative GZ CHB patients with high PT.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 89%

Section: Discussioncontrasting

confidence: 54%

Section: Discussionmentioning

confidence: 58%

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Significant histological disease of patients with chronic hepatitis B virus infection in the grey zone

Wang

Yan

Zhu

et al. 2022

Aliment Pharmacol Ther

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“…Notably, the estimated prevalence of significant fibrosis, advanced fibrosis, and cirrhosis was for HBeAg-positive chronic infection: 16.9% (95% CI 7.8–26.1), 5.4% (95% CI 0.0–11.2), and 0.0% (95%CI 0.0–1.5), respectively. The authors concluded that fibrosis risk persists throughout the natural course of CHB [ 32 ]. These studies provide a growing body of evidence that HBeAg-positive disease may well be associated with inflammation and fibrosis, even in the presence of persistently normal liver enzymes.…”

Section: Is Hbeag-positive Chronic Infection a Truly Benign Disease P...mentioning

confidence: 99%

Early Treatment Consideration in Patients with Hepatitis B ‘e’ Antigen-Positive Chronic Infection: Is It Time for a Paradigm Shift?

Koffas

Mak

Gill

et al. 2022

Viruses

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Chronic hepatitis B (CHB) is associated with significant morbidity and mortality, due to the adverse sequelae of cirrhosis and hepatocellular carcinoma (HCC). To date, antiviral therapy has been reserved for patients with ostensibly active liver disease, fibrosis or cirrhosis, and/or increased risk of HCC. Historically, patients with hepatitis B ‘e’ antigen (HBeAg)-positive chronic infection, were not offered antiviral therapy. Nevertheless, there has been compelling evidence emerging in recent years, demonstrating that this disease phase is in fact not characterized by immunological tolerance. HBV integration into the human genome is a frequent event found in these patients. Additionally, it may well be associated with active inflammation and fibrosis, even in the presence of persistently normal liver enzymes. Likewise, it appears that the mechanisms of hepatocarcinogenesis are already present during this early stage of the disease. This was reflected in the European Association for the Study of the Liver (EASL) guidelines, where treating patients above the age of 30 years with HBeAg-positive chronic infection was proposed. Lowering the treatment threshold to broaden treatment eligibility is likely to slow disease progression and reduce the risk of developing HCC. The current review discusses the reasons to consider early antiviral therapy in HBeAg-positive chronic infection.

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Major open questions in the hepatitis B and D field – Proceedings of the inaugural International emerging hepatitis B and hepatitis D researchers workshop

Tu,

Wettengel,

Xia

et al. 2024

Virology

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Liver Fibrosis in the Natural Course of Chronic Hepatitis B Viral Infection: A Systematic Review with Meta-Analysis

Cited by 12 publications

References 49 publications

Significant histological disease of patients with chronic hepatitis B virus infection in the grey zone

Significant histological disease of patients with chronic hepatitis B virus infection in the grey zone

Early Treatment Consideration in Patients with Hepatitis B ‘e’ Antigen-Positive Chronic Infection: Is It Time for a Paradigm Shift?

Major open questions in the hepatitis B and D field – Proceedings of the inaugural International emerging hepatitis B and hepatitis D researchers workshop

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