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Fibrosis assessment in patients with chronic hepatitis B virus (HBV) infection
Pathik Parikh1, John D Ryan1, Emmanuel A Tsochatzis1
1UCL Institute for Liver and Digestive Health and Sheila Sherlock Liver Unit, Royal Free Hospital and UCL, London, UK.
Insights
Non-invasive tests for liver fibrosis in chronic hepatitis B virus (HBV) infection are replacing liver biopsy. These blood and imaging tests aid in disease management and prognostication for millions worldwide.
Area of Science:
- Hepatology
- Virology
- Diagnostic Medicine
Background:
- Chronic hepatitis B virus (HBV) infection affects 250 million globally, posing risks for liver disease, decompensated cirrhosis, and hepatocellular carcinoma (HCC).
- Accurate staging of liver fibrosis is crucial for managing HBV infection and predicting patient outcomes.
- Expert assessment of serology, biochemistry, and disease stage is vital for timely monitoring and therapy initiation.
Purpose of the Study:
- To review methods for assessing liver fibrosis in chronic HBV infection.
- To focus on commonly used non-invasive blood- and imaging-based tests.
- To evaluate the diagnostic performance and clinical applicability of these non-invasive tests.
Main Methods:
- Review of current literature on liver fibrosis assessment in chronic HBV.
- Analysis of diagnostic performance data for non-invasive blood-based tests (e.g., biomarkers).
- Analysis of diagnostic performance data for non-invasive imaging-based tests (e.g., transient elastography, MRI).
Main Results:
- Non-invasive tests are increasingly replacing liver biopsy for staging HBV-related liver fibrosis.
- Blood- and imaging-based algorithms show promise in reliably staging disease in many patients.
- These non-invasive methods offer advantages over biopsy, including safety, cost, and speed, but may have limitations in intermediate stages or with co-existing conditions.
Conclusions:
- Non-invasive tests are becoming integral to HBV management guidelines.
- These methods provide a safer and more accessible alternative to liver biopsy for fibrosis assessment.
- Further validation and understanding of limitations are essential for optimal clinical application in chronic HBV patients.
Abstract:
Chronic hepatitis B virus (HBV) infection is a major cause of liver morbidity and mortality worldwide. While a proportion of the 250 million individuals chronically infected with HBV will not come to significant harm or require therapy, many others risk developing complications of the end-stage liver disease such as decompensated cirrhosis and hepatocellular carcinoma (HCC), without intervention. Due to the complex natural history of HBV infection, patients require an expert assessment to interpret biochemistry, viral serology and appropriately stage the disease, and to initiate monitoring and/or therapy where indicated. The detection and quantification of liver fibrosis is a key factor for disease management and prognostication for an individual with HBV. The reliance on invasive liver biopsy to stage disease is diminishing with the advent of robust non-invasive blood- and imaging-based algorithms which can reliably stage disease in many cases. These tests are now incorporated into International guidelines for HBV management and relied upon daily to inform clinical judgement. Both blood- and imaging-based approaches have advantages over liver biopsy, including minimal risks, lower cost, better patient acceptance and speed of results, while disadvantages include lower diagnostic accuracy in intermediate disease stages and variability with co-existing hepatic inflammation or steatosis. This review outlines the methods of fibrosis assessment in chronic HBV infection and focuses on the most commonly used blood- and imaging-based non-invasive tests, reviewing their diagnostic performance and applicability to patient care.
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