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HBeAg-positive CHB patients with indeterminate phase associated with a high risk of significant fibrosis
Yuanyuan Li1, Yijia Zhu2, Dongmei Gao3
1Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China.
Insights
Patients with HBeAg-positive chronic hepatitis B (CHB) in the indeterminate phase show increased liver fibrosis risk. This finding highlights the importance of monitoring indeterminate phase CHB patients for liver fibrosis progression.
Area of Science:
- Hepatology
- Virology
- Gastroenterology
Background:
- HBeAg-positive chronic hepatitis B (CHB) patients present distinct phases of viral activity.
- The indeterminate phase in CHB is less understood regarding liver fibrosis risk compared to the immune-tolerant phase.
Purpose of the Study:
- To compare the prevalence and severity of liver fibrosis in HBeAg-positive CHB patients across indeterminate and immune-tolerant phases.
- To identify risk factors associated with liver fibrosis in these patient groups.
Main Methods:
- A multi-center, retrospective cohort study of 719 treatment-naïve HBeAg-positive CHB patients with normal ALT.
- Patients were categorized into immune-tolerant (HBV DNA > 10^6 IU/mL) or indeterminate (HBV DNA ≤ 10^6 IU/mL) phases.
- Liver fibrosis and cirrhosis were assessed using APRI, FIB-4, transient elastography, and liver biopsy.
Main Results:
- Patients in the indeterminate phase exhibited significantly higher APRI, FIB-4 scores, and liver stiffness measurements compared to the immune-tolerant phase.
- The indeterminate phase was associated with a higher proportion of significant liver fibrosis (27.1% vs. 11.3%) and cirrhosis (14.3% vs. 3.2%).
- Indeterminate phase was an independent risk factor for significant fibrosis, particularly in patients aged 30 years or older.
Conclusions:
- HBeAg-positive CHB patients in the indeterminate phase experience more severe liver fibrosis than those in the immune-tolerant phase.
- The indeterminate phase represents a critical period for monitoring liver fibrosis progression in CHB patients.
Background:
The risk of liver fibrosis in HBeAg-positive chronic hepatitis B (CHB) patients with indeterminate phase is not well characterized. We aimed to compare the presence of liver fibrosis in HBeAg-positive CHB patients between indeterminate phase and immune-tolerant phase.
Methods:
This multi-center, retrospective cohort study included 719 treatment-naïve HBeAg-positive CHB patients with normal alanine aminotransferase (ALT). Patients with HBV DNA > 106 IU/mL were categorized into immune-tolerant phase, whereas those with HBV DNA ≤ 106 IU/mL were classified into indeterminate phase. Significant liver fibrosis and cirrhosis were determined by APRI, FIB-4, transient elastography, or liver biopsy.
Results:
The median age of patients was 33.0 years and 59.8% of patients were male. 81.5% and 18.5% of patients were in the immune-tolerant phase and indeterminate phase, respectively. The APRI (0.33 vs. 0.27, P < 0.001), FIB-4 (1.07 vs. 0.72, P < 0.001), and liver stiffness values (7.80 kPa vs. 5.65 kPa, P = 0.011) were higher in patients with indeterminate phase than those with immune-tolerant phase. Patients in the indeterminate phase had significantly higher proportions of significant fibrosis (27.1% vs. 11.3%, P < 0.001) and cirrhosis (14.3% vs. 3.2%, P < 0.001) compared to those in the immune-tolerant phase. In the multivariate analysis, indeterminate phase (OR 2.138, 95% CI 1.253, 3.649, P = 0.005) was associated with a higher risk of significant fibrosis, especially for patients aged ≥ 30 years.
Conclusion:
HBeAg-positive CHB patients in the indeterminate phase had more severe liver fibrosis compared to those in the immune-tolerant phase.
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