Liver Cirrhosis Is Common in HBeAg Negative Chronic Hepatitis B Patients, especially Those with High ALT and HBV DNA Levels

By Liz Highleyman

Researchers continue to explore factors -- including viral load and liver enzyme levels -- that indicate a need for treatment of patients with chronic hepatitis B virus (HBV) infection. Because repeated biopsies are expensive and unpleasant for patients, investigators have looked for non-invasive methods for assessing liver disease progression.

As reported in the December 2008 American Journal of Gastroenterology, Grace Lai-Hung Wong and colleagues from Hong Kong investigated the relationship between serum HBV DNA and alanine transaminase (ALT) levels and the risk of liver cirrhosis in a large cohort of hepatitis B "e" antigen (HBeAg) negative patients using the transient elastography method (commercially known as FibroScan).

The researchers prospectively studied 1197 treatment-naive HBeAg negative chronic hepatitis B patients recruited based on territory-wide referrals. Possible and probable cirrhosis were defined using 2 different transient elastography cut-offs based on the results from a subgroup of 100 patients with histological confirmation from biopsies.

Results

In the subgroup of 100 patients with liver biopsies, liver stiffness measurements of > 8.4 kiloPascals (kPa) had a sensitivity of 90% and > 13.4 kPa had a specificity of 94% for liver cirrhosis.

Using these cut-offs, 31% of the full cohort had possible cirrhosis and 11% had probable cirrhosis.

The risk of cirrhosis was significantly increased among patients with ALT > 0.5 times the upper limit of normal (x ULN) or serum HBV DNA > 4 log10 copies/mL.

Among patients with ALT < 0.5 x ULN and HBV DNA < 4 log10 copies/mL, 10% had possible cirrhosis and 3% had probable cirrhosis.

This was significantly lower than the 34% possible and14% probable cirrhosis rates in patients with higher ALT and HBV DNA levels.

"Liver cirrhosis was common among HBeAg negative chronic hepatitis B patients," the study authors concluded. "Patients with ALT levels > 0.5 x ULN and/or serum HBV DNA > 4 log10 copies/mL have higher risk of cirrhosis and need further assessment for antiviral therapy."

Institute of Digestive Disease, Department of Medicine and Therapeutics, and Department of Anatomical and Cellular Pathology, Chinese University of Hong Kong, Hong Kong SAR, China.

1/23/09

Reference
GL Wong, VW Wong PC Choi, and others. Evaluation of Alanine Transaminase and Hepatitis B Virus DNA to Predict Liver Cirrhosis in Hepatitis B e Antigen-Negative Chronic Hepatitis B Using Transient Elastography. American Journal of Gastroenterology 103(12): 3071-3081.December 2008. (Abstract and full text).