Diagnostic Dilemma for Low Viremia with Significant Fibrosis; is Hepatitis B Virus DNA Threshold Level a Good Indicator for Predicting Liver Damage?

• Published in: Balkan medical journal Vol. 35; no. 4; pp. 326 - 332
• Main Authors: Yenilmez, Ercan, Çetinkaya, Rıza Aytaç, Tural, Ersin
• Format: Journal Article
• Language: English
• Published: Turkey Galenos Yayinevi Tic. Ltd 01-08-2018; Trakya Üniversitesi; Aves Yayincilik Ltd. STI; Galenos Publishing; Galenos Publishing House
• Subjects: Antigens; Case-Control Studies; Chronic hepatitis B; Chronic illnesses; Deoxyribonucleic acid; Diagnosis; DNA; DNA, Viral - blood; Fibrosis; Genetic aspects; HBV DNA; Hepatitis; Hepatitis B; Hepatitis B - diagnosis; Hepatitis B virus; Hepatology; Histology; Hospitals; Humans; Infections; Inflammation; Interferon; Laboratories; Liver - pathology; Liver Cirrhosis - diagnosis; Liver Cirrhosis - pathology; Liver Cirrhosis - virology; Liver diseases; Male; Military service; Original; Pathology; prediction; Retrospective Studies; Studies; Substance abuse treatment; Systematic review; Tıp; Ultrasonic imaging; Viremia; Viremia - diagnosis; Viruses; Türkiye; Edirne; Turkey; Chronic hepatitis B, fibrosis, HBV DNA, prediction, viremia; HBV DNA; prediction; fibrosis; Chronic hepatitis B; viremia
• ISSN: 2146-3123; 2146-3131
• DOI: 10.4274/balkanmedj.2017.0888

The most important difficulties about management of hepatitis B are still determining the liver damage and the right time to start antiviral therapy.
To reveal the role of hepatitis B virus DNA threshold level for prediction of liver fibrosis and inflammation in young-aged hepatitis B e-antigen negative chronic hepatitis B patients.
Diagnostic accuracy study.
A total of 273 hepatitis B e-antigen negative young chronic hepatitis B patients with any hepatitis B virus DNA levels between 2008 and 2016, who had liver biopsy after at least 6 months follow up period, enrolled in this retrospective study. We created two groups as case and control, cases with hepatitis B virus DNA levels below 2000 IU/mL and controls with hepatitis B virus DNA levels over 2000 IU/mL. Having histological activity index ≥4 or/and fibrosis scores ≥2 were defined as significant histological abnormality. Then, we analyzed the relationship between these groups.
We showed that significant fibrosis may occur in one third of young chronic hepatitis B patients with low viremia (30.2%, n=42/139 in cases, 55.2%, n=74/134 in controls). Among the 42 cases with low viremia and significant fibrosis, 21.4% had alanine aminotransferase level between 40-59 U/L, 42.8% had alanine aminotransferase level between 60-79 U/L, and 35.7% had alanine aminotransferase level over 80 U/L. There was weak correlation between hepatitis B virus DNA threshold level and fibrosis score (p<0.001, rho=0.253). The optimum serum hepatitis B virus DNA threshold level in our study for predicting significant fibrosis was 1293 IU/mL (p<0.001, AUC: 0.657±0.034). The optimum alanine aminotransferase threshold level for predicting significant histological activity index and fibrosis was 64.5 and 59.5 U/L, respectively. The sensitivity and the specificity of 1293 vs 2000 IU/mL hepatitis B virus DNA threshold with 60 U/L alanine aminotransferase threshold level for predicting F≥2 fibrosis score were similar (sensitivity: 0.43 and 0.38, specificity: 0.76 and 0.77, respectively).
Significant fibrosis may occur even in young cases with low viremia. It is not possible to define a single threshold hepatitis B virus DNA level for differentiating inactive carriers from patients with hepatitis B e-antigen-negative chronic hepatitis. Diagnostic accuracy of hepatitis B virus DNA with alanine aminotransferase thresholds for the prediction of significant fibrosis is weak.