Prevalence of Fibrosis and Cirrhosis in Patients with Chronic Hepatitis B
By
Liz Highleyman  Over
years or decades, chronic hepatitis B virus (HBV)
infection can progress to severe liver disease including advanced fibrosis,
cirrhosis, and liver cancer.
As
reported in the June 2008 American Journal of Gastroenterology, a team
of researchers from Hong Kong conducted a study to document the prevalence and
factors associated with severe fibrosis and cirrhosis in a large population of
Asian chronic hepatitis B patients. Transient
elastography (FibroScan) was performed in 1315 unselected patients (72% of whom
were treatment-naive) to estimate the degree of fibrosis. A liver "stiffness"
score of < 8.1 kiloPascals (kPa) was used as a cut-off for the presence of
severe fibrosis or cirrhosis. Results
•
319
patients (34%) had severe fibrosis.
•
Severe
fibrosis was more common in males compared with females (39% vs 24% respectively;
P < 0.01.)
•
Severe
fibrosis was seen with increasing age, from 20% in patients younger than 25 years
to 81% in those older than 65 years.
•
A
higher prevalence of severe fibrosis was seen in hepatitis B "e" antigen
(HBeAg) positive compared with HBeAg negative patients older than 45 years (58%
vs 43%, respectively; P = 0.03).
•
Prevalence
was higher among patients with HBV DNA levels of 4 log or greater compared to
those with less than 4 log copies/mL (41% vs 27%; P < 0.01).
•
Prevalence
was also higher among patients with increasing alanine aminotransferase (ALT)
levels (11% if < 0.5 x ULN, 30% if 0.5-1 x ULN, 48% if 1-2 x ULN; P < 0.01).
•
In
a multivariate analysis, sex, age and ALT levels were significant factors associated
with severe fibrosis.
•
Patients
who received antiviral therapy had lower ALT levels (25 vs 35 U/L; P < 0.01),
liver stiffness scores (6.2 vs 6.7 kPa; P = 0.031), and prevalence of cirrhosis
(14% vs 22%; P = 0.008) compared with untreated inidviduals.
 Based
on these findings, the study authors concluded, "The overall prevalence of
severe fibrosis in chronic hepatitis B patients was 34%, with higher rates seen
in older age groups, males, and in patients with higher ALT levels."
This
study adds to the evidence that antiviral treatment can slow or prevent progression
to advanced liver disease in people with chronic HBV infection.
7/15/08
Reference
J
Fung, CL Lai, D But, and others. Prevalence of fibrosis and cirrhosis in chronic
hepatitis B: implications for treatment and management. American Journal of
Gastroenterology 103(6): 1421-1426. |
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