Non-invasive assessment of liver fibrosis in patients with HBV-related chronic liver disease undergoing antiviral treatment: A preliminary study

Abstract

In chronic hepatitis B (CHB) patients, fibrosis assessment during antiviral treatment is a key step in the clinical management. Aim of this study was to evaluate the performance of elastography in assessing fibrosis stage in CHB before and after two years of nucleoside/nucleotide analogues (NUC) treatment in comparison with indirect serum markers. CHB diagnosis was made according to standard criteria. A clinical and virological evaluation was performed at baseline and again at 3, 6, 9, 12 18, and 24 months during treatment. Fibrosis was evaluated by liver biopsy, elastography and indirect serum markers. Of 75 patients, 50 had CHB, HBeAg negative and were deemed eligible for this study. Of these, 22 underwent liver biopsy. Mean histo-morphometric values of fibrotic tissue differed significantly in the stage< S3 vs. stage ≥S3: 2.01±2.62% vs. 12.85±7.31% (p=0.03), respectively. At 18 and 24 months, stiffness values were statistically reduced from those previously observed (P=0.03 and P<0.001). At 24 months the values of APRI, FIB-4 and LOK were not different from baseline values, while the value of FORNS score at 24 months was the only one statistically reduced. In two patients with fibrosis stage S3 and S6, respectively, fibrosis regressed to stage S2 and S5. In conclusion, the results of the present study show that liver histology, stiffness and FORNS score improve significantly during a long-term follow-up of HBV patients successfully treated with NUC. These results strongly suggest that the non-invasive evaluation of liver fibrosis represents a key step in the management and treatment of chronic HBV hepatitis.

Acoustic Radiation Force Impulse US Imaging: Liver Stiffness in Patients with Chronic Hepatitis B with and without Antiviral Therapy

“…Although AST-to-platelet ratio index and FIB-4 index are associated with significant fibrosis and cirrhosis in patients with chronic hepatitis B before antiviral therapy (16), AST-to-platelet ratio index and FIB-4 have been proven not suitable for the evaluation of fibrosis improvement in chronic hepatitis B patients receiving antiviral therapy (25). On the other hand, serial tissue elastography examinations by FibroScan correlate well with the regression of liver fibrosis after antiviral therapy (26), and liver fibrosis improves significantly after 5-year antiviral therapy as monitored by FibroScan in chronic hepatitis B patients with advanced fibrosis (27). However, there were no nontreatment groups (as control) for comparison in previous studies.…”

A composite noninvasive index correlates with liver fibrosis scores in post-Fontan patients: Preliminary findings

“…In patients with infectious hepatitis, nonalcoholic fatty liver disease, and alcoholic liver disease, composite models comprised of laboratory values, patient characteristics, and hepatic elastography either by magnetic resonance or ultrasound, have been developed primarily to predict the presence of cirrhosis . However, to the best of our knowledge, there are only two post‐Fontan reports, with 10 patients each, that have compared liver biopsy findings with either magnetic resonance or ultrasound hepatic elastography .…”

“…Notwithstanding its limitations, secondary to sampling and intraobserver and interobserver variations, liver biopsy is the accepted gold standard for determining the degree of hepatic fibrosis, regardless the etiology; nevertheless, a noninvasive method that correlates with the degree of liver fibrosis would be a more practical clinical approach. Previous, large patient cohort studies report correlations between liver pathology and noninvasive methods, including composite models comprised of multiple patient variables, in those with infectious hepatitis, nonalcoholic fatty liver disease, and alcoholic liver disease . However, there are few reports comparing liver biopsy findings with noninvasive approaches in patients with Fontan associated liver disease (FALD); thus, there are no current, useful, clinic‐based, noninvasive methods that strongly correlate one with the other .…”

“…Previous, large patient cohort studies report correlations between liver pathology and noninvasive methods, including composite models comprised of multiple patient variables, in those with infectious hepatitis, nonalcoholic fatty liver disease, and alcoholic liver disease. [7][8][9][10][11][12][13][14][15] However, there are few reports comparing liver biopsy findings with noninvasive approaches in patients with Fontan associated liver disease (FALD); thus, there are no current, useful, clinic-based, noninvasive methods that strongly correlate one with the other. 4,5,[16][17][18][19][20][21] This study reports our experience comparing post-Fontan hepatic biopsy findings with a composite, noninvasive index derived from liver-ultrasound, shearwave elastography (SWE) measurements, model for end-stage liver disease excluding INR (MELD-XI) scores, and time post-Fontan.…”

Evaluating Noninvasive Markers to Identify Advanced Fibrosis by Liver Biopsy in HBV/HIV Co‐infected Adults

“…(15)(16)(17)(18)(19)(20)(21) Most of these co-infected patients are on combination antiretroviral therapy (cART), which includes medications that suppress HBV and may affect the performance of noninvasive tests. (22) Although several studies have reported a single noninvasive marker of fibrosis in HBV-HIV subjects on cART, (23)(24)(25)(26)(27) few investigations have evaluated the discriminatory capacity of noninvasive markers (i.e., with comparisons to liver histology as the gold standard) in this special population, (28)(29)(30) and only one has compared the relative discriminatory capacity of APRI and FIB-4, the two most widely used serum-based markers, to VCTE. (31) Although most HBV-HIV co-infected subjects on cART have suppressed HBV DNA and normal liver enzymes, we have previously shown that a high proportion can have significant underlying fibrosis.…”