Predictors of Significant Fibrosis in Chronic Hepatitis B Patients With Low Viremia

• Published in: Journal of clinical gastroenterology Vol. 48; no. 6; pp. e50 - e56
• Main Authors: Abdo, Ayman A, Bzeizi, Khalid I, Babatin, Mohammed A, AlSohaibani, Fahad, AlMana, Hadeel, Alsaad, Khaled O, AlGhamdi, Hamdan, Al-Hamoudi, Waleed, AlSwat, Khalid, AlFaleh, Faleh Z, Myers, Robert P, Sanai, Faisal M
• Format: Journal Article
• Language: English
• Published: United States by Lippincott Williams & Wilkins 01-07-2014
• Subjects: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Alanine Transaminase - metabolism; Aspartate Aminotransferases - metabolism; DNA, Viral - isolation & purification; Female; Hepatitis B virus - isolation & purification; Hepatitis B, Chronic - complications; Hepatitis B, Chronic - virology; Humans; Liver Cirrhosis - epidemiology; Liver Cirrhosis - virology; Logistic Models; Male; Middle Aged; Multivariate Analysis; Prevalence; Viremia - epidemiology; Young Adult
• ISSN: 0192-0790; 1539-2031
• DOI: 10.1097/MCG.0b013e3182a9a2e1

BACKGROUND AND AIM:The data on the prevalence and predictors of significant fibrosis (≥F2, METAVIR) in chronic hepatitis B virus (HBV) patients with low viremia are limited. We aimed to assess both the prevalence predictors of ≥F2 fibrosis in hepatitis B envelope antigen-negative patients with HBV DNA <20,000 IU/mL.
METHODS:Hepatitis B envelope antigen-negative patients (n=213) with mean HBV DNA <2000 IU/mL (n=97) and HBV DNA 2000 to 20,000 IU/mL (n=116) were included and all had liver biopsy. Variables significantly associated with ≥F2 fibrosis on an univariate analysis were included in a multivariate logistic regression model.
RESULTS:Overall, 40 (18.8%) patients had ≥F2 fibrosis, with no difference between those with mean HBV DNA <2000 IU/mL (19.6%) compared with patients with HBV DNA of 2000 to 20,000 IU/mL (18.1%; P=0.782). Fibrosis ≥F2 was similar in patients with HBV DNA <2000 versus 2000 to 20,000 IU/mL in relation to varying alanine aminotransferase thresholds (P>0.05), and was less frequent in persistently normal alanine aminotransferase patients (13.6%) when compared with those with elevated or fluctuating levels (25.3%, P=0.030). Fewer patients under 40 years of age had ≥F2 fibrosis (12.5%) as compared with older ones (28.2%; P=0.004). Logistic regression analysis identified higher aspartate aminotransferase [odds ratio (OR), 6.21; 95% confidence interval (CI), 2.48-15.54; P<0.0001], lower albumin (OR, 0.86; 95% CI, 0.78-0.95; P=0.002), platelet count (OR, 0.99; 95% CI, 0.98-0.99; P=0.013), and age (OR, 1.05; 95% CI, 1.01-1.09; P=0.024) as independent predictors of significant fibrosis.
CONCLUSIONS:A small but significant minority of HBV patients with low viremia harbor significant fibrosis, although its rate is not different in those with viremia above or below 2000 IU/mL. Our findings may guide in decisions regarding liver biopsy and treatment in this category of patients.