Prevalence of fibrosis and cirrhosis in chronic hepatitis B: implications for treatment and management

Abstract

AIM: To document the prevalence and factors associated with severe fibrosis and cirrhosis in a large population of Asian chronic hepatitis B (CHB) patients. METHODS: Transient elastography was performed in unselected CHB patients using Fibroscan (Echosens, France). Liver stiffness score of >8.1 kPa was used as a cut-off for the presence of severe fibrosis or liver cirrhosis. Demographics and laboratory parameters were recorded. Results: A total of 951 patients were recruited, of which 605 (64%) were males, with median age of 43 years, and positive HBeAg in 226 (24%). Overall 319 (34%) had severe fibrosis, with higher prevalence seen in males compared with females (39% vs 24% respectively, p< 25 years to 81% in those >65 years. In patients who were ≤45 years of age, there was no significant difference in prevalence of severe fibrosis between HBeAg-positive and HBeAg-negative patients. After the age of 45 years, higher prevalence of severe fibrosis was seen in HBeAg(+) patients compared to HBeAg(-) patients (58% vs 43% respectively, p=0.03). There was also increasing prevalence of severe fibrosis with increasing ALT levels: in patients with ALT less than 0.5 x upper limit of normal (ULN) and 0.5-1 x ULN (11% vs 30% respectively, p5 x ULN. Higher prevalence of fibrosis was seen in patients with HBV DNA ≥4 log copies/ml compared to those below this level (41% vs 27% respectively …