Increasing hepatitis B viral load is associatedwith riskof signi¢cant liver
¢brosis in HBeAg-negative but not HBeAg-positive chronic hepatitis B
Catherine M. N. Croagh1, Sally J. Bell1, John Slavin2, Yu X. G. Kong1, Robert Y Chen1, Stephen Locarnini3 and
Paul V Desmond1
1 Department of Gastroenterology, St Vincent’s Hospital, Fitzroy, Vic., Australia
2 Department of Pathology, St Vincent’s Hospital, Fitzroy, Vic., Australia
3 Victorian Infectious Diseases Reference Laboratory, North Melbourne, Vic., Australia
Conclusions
Our study of an Australian clinical cohort confirms that
CHB is associated with relatively high rates of significant
fibrosis, especially among ENHR patients, representing
the immune escape phase of disease or chronic HBeAgnegative
Hepatitis B. We confirm that there is a positive
correlation between high HBV DNA levels and the
presence of significant liver fibrosis in HBeAg-negative
disease but not in HBeAg-positive disease, and outline a
potential explanation for this based on the underlying
phase of disease. The factors predictive of significant
histological disease were age in HBeAg-positive patients,
and both HBV DNA and ALT in HBeAg-negative
patients.
The risk of liver inflammation and fibrosis in chronic
hepatitis B is the complex result of many interacting
factors and we argue that it is best considered in the
context of the traditional phase of disease model rather
than as a simple function of any single factor alone. In
particular, the HBV DNA level should not be relied on in
isolation to predict significant fibrosis/inflammation, but
rather needs to be interpreted as a measure of risk in the
context of other factors especially HBeAg status.