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ABSTRACT: Background
Guidelines recommend liver biopsy to rule out significant inflammatory activity in chronic hepatitis B (CHB) patients with elevated hepatitis B virus (HBV) DNA but without other indications for treatment.Aim
To study rates and determinants of clinically significant liver inflammation.Methods
We selected patients with HBV DNA > 2000 IU/mL from the SONIC-B database. The presence of significant inflammation (METAVIR ≥ A2 or HAI ≥ 9) was assessed by liver biopsy and correlated with alanine aminotransferase (ALT) levels (according to AASLD upper limits of normal [ULN]) and stratified by the presence of significant liver fibrosis (Ishak ≥ 3 or METAVIR ≥ F2).Results
The cohort included 2991 patients; 1672 were HBeAg-positive. ALT was < ULN in 270 (9%), 1-2 times ULN in 852 (29%) and > 2 times ULN in 1869 (63%). Significant fibrosis was found in 1419 (47%) and significant inflammatory activity in 630 (21%). Significant inflammatory activity was found in 34% of patients with liver fibrosis, compared to 9.5% of those without (P < 0.001). Among patients without fibrosis, significant inflammatory activity was detected in 3.6% of those with normal ALT, 5.0% of those with ALT 1-2 times ULN and in 13% of those with ALT > 2 times ULN (P < 0.001). ALT < 2 times ULN had a negative predictive value of 95% for ruling out significant inflammatory activity among patients without liver fibrosis.Conclusions
Among patients without significant fibrosis, an ALT level < 2 times ULN is associated with < 5% probability of significant inflammatory activity. If fibrosis can be ruled out using non-invasive methods, liver biopsy solely to assess inflammatory activity should be discouraged.
SUBMITTER: Sonneveld MJ
PROVIDER: S-EPMC7540526 | biostudies-literature | 2020 Oct
REPOSITORIES: biostudies-literature
Sonneveld Milan J MJ Brouwer Willem P WP Hansen Bettina E BE Chan Henry L-Y HL Piratvisuth Teerha T Jia Ji-Dong JD Zeuzem Stefan S Chien Rong-Nan RN Choi Hannah H de Knegt Robert J RJ Wat Cynthia C Pavlovic Vedran V Gaggar Anuj A Xie Qing Q Buti Maria M de Man Robert A RA Janssen Harry L A HLA
Alimentary pharmacology & therapeutics 20200904 8
<h4>Background</h4>Guidelines recommend liver biopsy to rule out significant inflammatory activity in chronic hepatitis B (CHB) patients with elevated hepatitis B virus (HBV) DNA but without other indications for treatment.<h4>Aim</h4>To study rates and determinants of clinically significant liver inflammation.<h4>Methods</h4>We selected patients with HBV DNA > 2000 IU/mL from the SONIC-B database. The presence of significant inflammation (METAVIR ≥ A2 or HAI ≥ 9) was assessed by liver biopsy an ...[more]