Reversibility of cirrhosis in chronic hepatitis B

Hepatic fibrosis and cirrhosis are the consequences of many types of chronic liver disease, and, at its final stage when liver nodule and scarring develop, they are generally considered to be irreversible.

Here we describe 3 patients with chronic hepatitis B with clinical, biochemical, and histologic evidence of cirrhosis. They underwent treatment with interferon-alpha or lamivudine and had follow-up liver biopsy while in clinical, biochemical, and virologic remission. Biopsy specimens were randomly coded in unpaired manner according to patient, and they were read independently by 2 pathologists using the modified hepatitis activity index (with a maximum stage of 6). The mean interval between biopsies was 5.5 years.

The mean ALT level decreased from 113.7 to 28.3 U/L. The mean bilirubin level decreased from 2.4 to 0.9 mg/dL, and the mean prothrombin time decreased from 16.3 to 12.3 seconds. The mean Child-Pugh score decreased from 8 to 5. The mean fibrosis score decreased from 5.8 to 0.5 (P = 0.004), and the mean grading score decreased from 10.8 to 3.2 (P = 0.017).

Cirrhosis due to chronic hepatitis B might be reversible in some patients who respond to antiviral therapy.