Lower prevalence of hepatic fibrosis in low viremic hepatitis B patients with fluctuating HBV DNA levels

Abstract

Background: In chronic hepatitis B virus (HBV) patients, fluctuations in HBV DNA serve as a “gray area” and impede the accurate identification of inactive carriers. We aimed to assess if such fluctuations impact the presence of significant hepatic fibrosis (Metavir F2-4) in chronic HBV patients. Methods: Consecutive, untreated HBeAg-negative carriers ( n = 234) with fluctuating HBV DNA ( n = 73) above or below a level of 2000 IU/mL were included and compared to those without fluctuations ( n = 161). Patients without fluctuating HBV DNA were further analyzed based on those with persistently low (<2,000 IU/mL, n = 137) and higher HBV DNA (2,000–20,000 IU/mL, n = 24). Hepatic fibrosis (assessed by transient elastography) was correlated with virologic and biochemical profiles. Results: The mean age of the overall cohort was 47.8 ± 11.1 years, of whom 107 (45.7%) were male. During a median of 60 months (interquartile range [IQR] 34–82) of follow-up, 73 (31.2%) patients had a mean of 1.6 ± 0.9 fluctuations in HBV DNA. The median time to the first fluctuation was at 14.5 (IQR 5.0–33.7) months. Patients with fluctuating viremia had higher log 10 qHBsAg (3.1 ± 0.8 vs. 2.7 ± 1.0, P = 0.022) and HBV DNA (3.4 ± 0.5 vs. 2.7 ± 0.8, P < 0.001) compared to those without fluctuations. Patients with fluctuant viremia were less likely to have F2-4 fibrosis (8.2%) compared to those without fluctuant viremia (18.2%, odds ratio [OR]: 0.407, 95% confidence interval [CI]: 0.161–1.030; P = 0.052). Males tended to have less fluctuation constituting 37.0% of patients with fluctuating HBV DNA ( P = 0.071). Fluctuations occurred more frequently in those with predominantly higher HBV DNA levels (26.0%) compared to those without fluctuations (14.9%; P = 0.030). Conclusions: Fluctuating HBV DNA levels occur frequently but are not associated with significant fibrosis. Minor fluctuations in HBV DNA levels are unlikely to be of clinical relevance.

Fluctuating hepatitis B viremia: Full of sound and fury, signifying nothing?

“…The management of CHB is complex and the decision to start viral suppression therapy is dependent on clinical factors including HBV DNA levels, liver inflammation, and/or fibrosis. In this issue of the Saudi Journal of Gastroenterology, Sanai et al [ 1 ] retrospectively evaluated CHB patients with negative HBe antigen and fluctuating HBV DNA levels (2000 to 20000 IU/mL) vs those without fluctuation (persistently below 2000 IU/mL), comparing their risk of developing of significant hepatic fibrosis. They observed no significant association with HBV DNA levels and liver fibrosis.…”

Shedding light on the “gray zone”: Hepatic fibrosis in chronic hepatitis B patients with fluctuating HBV DNA levels

“…We read with interest the article by Sanai and colleagues who evaluated the presence of F2-F4 fibrosis in this subclass of CHB patients. [ 5 ] This article provides prospective data on this patient populatio n which is not described elsewhere in the literature. Two hundred and thirty-four CHB patients without decompensated cirrhosis, significant alcohol intake (>20 g/day) or comorbid liver disease were identified, of which 73 (31.2%) had HBV DNA fluctuation.…”