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Published on: February 19, 2019
[Liver histopathological features of chronic HBV carriers and inactive HBsAg carriers]
Hui-min Fan1, Zhan Yang, Chun-lan Zhang
1Guangzhou Eighth People's Hospital, Guangzhou 510060, China.
Insights
Most chronic hepatitis B virus (HBV) carriers show liver inflammation and fibrosis, with more severe changes in those older than 40. Liver fibrosis is also present in carriers negative for hepatitis B e antigen (HBeAg).
Area of Science:
- Hepatology
- Virology
- Immunohistochemistry
Context:
- Chronic hepatitis B virus (HBV) infection affects millions globally.
- Distinguishing between chronic carriers and inactive carriers is crucial for management.
- Liver histopathology provides insights into disease progression.
Purpose:
- To investigate and compare the liver histopathological features of chronic HBV carriers and inactive HBsAg carriers.
- To correlate HBV DNA levels, HBeAg status, and age with liver damage severity.
Summary:
- 95% of carriers exhibited histological liver changes, with 8.65% showing severe changes (G3-4/S3-4).
- No significant difference in liver damage was found between chronic HBV and inactive HBsAg carriers.
- Severe fibrosis was more common in HBeAg-negative carriers and those over 40, though age groups showed no significant difference in overall inflammation or fibrosis.
Impact:
- Highlights the prevalence of liver inflammation and fibrosis in HBV carriers, even with normal ALT.
- Identifies HBeAg negativity and older age as potential indicators for more severe fibrosis.
- Demonstrates the utility of immunohistochemistry in detecting HBcAg in liver tissue, even with negative serological HBV DNA.
Objective:
To study the liver histopathological features of chronic HBV carriers and inactive HBsAg carriers.
Methods:
Liver biopsies were performed on 189 chronic HBV carriers and 30 inactive HBsAg carriers (219 cases in total). All of them had a normal serum ALT value; they were then followed-up for more than 6 months. HBsAg and HBcAg were detected by immunohistochemistry. The circulating HBV DNA loads and serologic markers of HBV were examined at the same time. Grades of liver necrosis/inflammation and fibrosis were compared between the patients regarding their HBV DNA positivity or negativity. The relationships between the HBeAg positivity and degrees of liver histological changes were evaluated. The grades of liver necrosis/inflammation and fibrosis were compared between three age groups: younger than 18 years, 18-40, and older than 40 years.
Results:
Two hundred eight carriers of the total 219 (95.0%) had histological liver changes. Fifty percent (104/208) of them had mild histological changes (G0-1/S0-1), while more severe changes (G3-4 and/or S3-4) were found in 18 out of the 208. There were no significant differences in the grades of liver necrosis/inflammation and fibrosis between the chronic HBV carriers and the inactive HBsAg carriers. Among the serologic HBV DNA positive carriers, hepatic fibrosis was more severe in the HBeAg negative group than in the positive group (chi2 = 9.551, P = 0.008), but no differences of the necrosis/inflammation grades were seen between the two groups. The rate of severe fibrosis (S3-4) was 21.1% in those carriers older than 40 years but was 7.7% in patients younger than 18 years. However, no statistically significant differences in degrees of liver inflammation and fibrosis were found among the three age groups. HBcAg positive rate was 100% in the liver tissues of all the chronic HBV carriers, but only in 33.3% in the inactive HBsAg carriers.
Conclusions:
The majority of our HBV carriers have liver inflammation and fibrosis. More severe histological changes were found in 8.65% of them. Liver fibrosis existed in the carriers with negative HBeAg and in those older than 40 years. HBcAg was found in hepatic tissues while their serological HBV DNA was negative.
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