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VIRAL LOAD AND LIVER STIFFNESS ARE RELATED TO
SIGNIFICANT FIBROSIS AND DISEASE PROGRESSION IN
HBEAG NEGATIVE PATIENTS. A REAL-LIFE COHORT STUDY.
Luisa Roade1,2, Mar Riveiro Barciela3, Elena Vargas-Accarino4,
Adriana Palom1,4, Ana Barreira-Diaz1, Cristina Marcos Fosch1,
Maria Asuncion Buti Ferret3 and Rafael Esteban-Mur5, (1)
Liver Unit, Internal Medicine Department. Hospital Universitari
Vall d’Hebron, Barcelona, Spain, (2)Centro De Investigación
Biomédica En Red, Enfermedades Hepáticas y Digestvas
(CIBERehd), Instituto De Salud Carlos III, Madrid, Spain, (3)
Liver Unit, Internal Medicine Department. Hospital Universitari
Vall d’Hebron, Barcelona, Spain, University Hospital Vall
D’hebron, (4)Vall D’hebron Institut De Recerca, (5)Liver Unit,
Hospital Vall D’hebron
Background: management of chronic hepatitis B virus
infection is challenging due to its dynamic nature and the
prognosis of different stages of HBV infection Despite noninvasive
markers, liver biopsy is still needed in majority of cases
to characterize these patients Aim: to assess the usefulness
of non-invasive markers in HBeAg-negative individuals for
the prediction of significant fibrosis and treatment eligibility
criteria Methods: observational study of HBeAg negative
subjects chronically infected by HBV Clinical, serological and
virological data were collected annually. Liver fibrosis was
estimated through liver stiffness measurement (LSM) and
non-invasive biomarkers (APRI and FIB-4) Subjects were
classified at baseline in HBV chronic carriers, HBeAg negative
chronic hepatitis B (CHB) and grey zone (normal ALT+HBVDNA
>2000 IU/mL) and reclassified at the end of follow-up. A
liver biopsy was performed in patients with persistent HBVDNA>
2, 000 IU/mL +normal ALT). Results: 372 subjects
were included; baseline characteristics are summarized
in table1. At baseline 244 (66%) were classified as chronic
carriers, 22(6%) as HBeAg negative CHB and 106(29%)
as grey zone Liver biopsy was performed in 92 individuals
(25%) with significant fibrosis (F≥2 Ishak) in 21(23%). Those
undergoing liver biopsy presented baseline higher ALT (26 vs
50IU/ml, p<0 0001), qHBsAg (3 vs 3 6 log IU/ml, p<0 001),
HBV DNA(2 4 vs 3 8log IU/ml, p<0 001) and LSM (5 4kPa vs
6 3kPa, p=0 012) Baseline factors independently associated
with significant fibrosis were higher HBV-DNA (reference
<2000IU/ml vs 2000-20000IU/ml vs 20000IU/ml, OR=6 6)
and LSM (LSM>6.5kPa, OR=2.9). Baseline LSM showed
an AUROC of 0.8 for identification of significant fibrosis. Out
of 335 individuals with ≥1follow-up, 285(85%) were finally
considered chronic carriers and 43(13%) CHB Among 106
patients classified as grey zone, HBV-DNA (OR=3.1), and
LSM (OR=6.1) were associated with later classification as
CHB. 7 subjects remained unclassifiable due to high viral
loads with mild/absent fibrosis in liver sample. 47 subjects
initiated HBV therapy during follow-up, HBsAg was lost in
24(6 5%) and one decompensation and one liver-related
death were registered Conclusion: baseline viral load and
liver stiffness are the only predictors for significant fibrosis
and evolution to CHB in a real-life cohort of HBeAg negative
subjects An invasive approach is needed in up to 25% of
subjects for proper classification.作者: StephenW 时间: 2020-10-24 13:57