The Impact of Transient Elastography in the Assessment and Follow-up of Patients with HBeAg-Negative Chronic Hepatitis B Virus Infection

Liver fibrosis is the main prognostic factor for chronic hepatitis B (CHB). Change of inactive hepatitis B to active one is usually done silently. In this setting accurate estimation of fibrosis is an important step in the management of affected patients.
The aim of this study was to determine the impact of fibroscan to evaluate liver fibrosis in inactive chronic hepatitis B.

In a prospective study between February 2016 and June 2018, we evaluated liver fibrosis among patients with inactive CHB by fibroscan assessment. The inclusion criteria were the presence of serum HBsAg more than 6 months, persistence normal liver enzymes during the last 6 months, and HBV–DNA viral load<20000 IU/mL. All other liver diseases were excluded. All patients underwent liver fibroscan. The factors affecting fibroscan results such as severe obesity, cardiac and renal failure, decompensate cirrhosis, and ascites were excluded. The patients were visited every 6 months. The eligible patients were followed up for one year.

 210 patients were enrolled in this study. The mean age was 37.49±12.8 years and of them132 patients were male. Regarding the HBV DNA load, 48(22.9%), 84(40%), and 78(37.1%) patient had viral load undetectable, under, and more than 2000IU/mL, respectively. The mean transit elastography (TE) value among these patients was 5.8±1.26 kPa. TE value more than 7.2 kp was seen in 25 (11.9%) patients with mean of 8.1±1.4 kPa. There was no significant association between TE results and viral load levels in general. Moreover, we did not observe a significant association between age and viral load and TE.

We showed that inactive hepatitis B is not a benign condition, which needed regular follow-up by evaluating liver enzymes, vial load, and TE.  Hepatic fibrosis has prognostic significance because afflicted patients are at higher risk of developing cirrhosis; although liver biopsy is considered as the best available gold standard for assessing hepatic fibrosis.