Discriminant value of serum HBV DNA levels as predictors of liver fibrosis in chronic hepatitis B

[Guest guest]

J Viral Hepat. 2011 Jul;18(7):e217-e225. doi: 10.1111/j.1365-2893.2011.01437.x.

Epub 2011 Mar 1.

Discriminant value of serum HBV DNA levels as predictors of liver fibrosis in

chronic hepatitis B.

Sanai FM, Helmy A, Bzeizi KI, Babatin MA, Al-Qahtani A, Al-Ashgar HA, Al-Mdani

AS, Al-Akwaa A, Almutharea S, Khan MQ, Alghamdi AS, Farah T, Al-Hamoudi W,

Saadeh M, Abdo AA.

Source

Department of Hepatobiliary Sciences, King Abdulaziz Medical City, Riyadh, KSA

Division of Gastroenterology, Department of Medicine, King Faisal Specialist

Hospital & Research Center, Riyadh, KSA Gastroenterology Department, Riyadh

Military Hospital, Riyadh, KSA Division of Gastroenterology, Department of

Medicine, King Fahad General Hospital, Jeddah, KSA Department of Molecular

Virology, Research Center, King Faisal Specialist Hospital & Research Center,

Riyadh, KSA Department of Medicine, King Abdulaziz Medical City, Al-Ahsa, KSA

Division of Gastroenterology, Department of Medicine, King Khalid University

Hospital, King Saud University, Riyadh, KSA Clinical Research Center, King

Abdullah International Medical Research Center, National Guard Health Affairs,

Riyadh, KSA Liver Disease Research Center, King Saud University, Riyadh, KSA.

Abstract

Summary.  Current guidelines recommend antiviral therapy in chronic hepatitis

B (HBV) patients with significant histological disease. We aimed to compare

histological fibrosis (METAVIR, ≥F2) in patients with HBV DNA

≥20 000 IU/mL vs≥2000 IU/mL and identify predictors of fibrosis. We

performed prospective liver biopsies on 203 HBeAg-negative patients in four

groups: Group I (n = 55): HBV DNA ≥20 000 IU/mL and persistently

elevated alanine aminotransferase (ALT) levels (PEALT; >40 U/L); Group II

(n = 34): HBV DNA ≥20 000 IU/mL and persistently normal ALT (PNALT);

Group III (n = 40): HBV DNA <20 000 IU/mL and PEALT; and Group IV

(n = 74): HBV DNA <20 000 IU/mL, and PNALT. We reanalysed all groups in

relation to updated cut-off for treatable viremia (2000 IU/mL). Genotype D was

detected in 86% of patients. Hepatic fibrosis ≥F2 was detected in 72.7%,

52.9%, 57.5% and 18.9% in Groups I-IV, respectively (P < 0.0001). Except in

Group II with a trend for lower ≥F2 fibrosis (P = 0.067), there was no

significant difference by using HBV DNA cut-off 20 000 vs 2000 IU/mL.

Multivariate logistic regression analysis identified study Group IV (OR, 0.0276;

CI: 0.088-0.868; P = 0.0276) and milder (A0-1) necroinflammatory grade (OR,

0.135; CI: 0.063-0.287; P < 0.0001) as independent predictors of ≥F2

fibrosis. The specificity, positive and negative predictive values for PEALT in

detection of ≥F2 fibrosis for viremia ≥2000 IU/mL (80%, 69% and 65%,

respectively) or ≥20 000 IU/mL (86%, 73% and 63%, respectively) were

similar, with a marginal gain in sensitivity (51%vs 42%, respectively).

Significant fibrosis is prevalent in a large proportion of HBeAg-negative

patients with high viremia and persistently normal ALT. Lower HBV DNA cut-offs

could be adopted with marginal gains in fibrosis detection and without loss of

diagnostic accuracy.

© 2011 Blackwell Publishing Ltd.

PMID: 21692936 [PubMed - as supplied by publisher]

[Guest guest]

J Viral Hepat. 2011 Jul;18(7):e217-e225. doi: 10.1111/j.1365-2893.2011.01437.x.

Epub 2011 Mar 1.

Discriminant value of serum HBV DNA levels as predictors of liver fibrosis in

chronic hepatitis B.

Sanai FM, Helmy A, Bzeizi KI, Babatin MA, Al-Qahtani A, Al-Ashgar HA, Al-Mdani

AS, Al-Akwaa A, Almutharea S, Khan MQ, Alghamdi AS, Farah T, Al-Hamoudi W,

Saadeh M, Abdo AA.

Source

Department of Hepatobiliary Sciences, King Abdulaziz Medical City, Riyadh, KSA

Division of Gastroenterology, Department of Medicine, King Faisal Specialist

Hospital & Research Center, Riyadh, KSA Gastroenterology Department, Riyadh

Military Hospital, Riyadh, KSA Division of Gastroenterology, Department of

Medicine, King Fahad General Hospital, Jeddah, KSA Department of Molecular

Virology, Research Center, King Faisal Specialist Hospital & Research Center,

Riyadh, KSA Department of Medicine, King Abdulaziz Medical City, Al-Ahsa, KSA

Division of Gastroenterology, Department of Medicine, King Khalid University

Hospital, King Saud University, Riyadh, KSA Clinical Research Center, King

Abdullah International Medical Research Center, National Guard Health Affairs,

Riyadh, KSA Liver Disease Research Center, King Saud University, Riyadh, KSA.

Abstract

Summary.  Current guidelines recommend antiviral therapy in chronic hepatitis

B (HBV) patients with significant histological disease. We aimed to compare

histological fibrosis (METAVIR, ≥F2) in patients with HBV DNA

≥20 000 IU/mL vs≥2000 IU/mL and identify predictors of fibrosis. We

performed prospective liver biopsies on 203 HBeAg-negative patients in four

groups: Group I (n = 55): HBV DNA ≥20 000 IU/mL and persistently

elevated alanine aminotransferase (ALT) levels (PEALT; >40 U/L); Group II

(n = 34): HBV DNA ≥20 000 IU/mL and persistently normal ALT (PNALT);

Group III (n = 40): HBV DNA <20 000 IU/mL and PEALT; and Group IV

(n = 74): HBV DNA <20 000 IU/mL, and PNALT. We reanalysed all groups in

relation to updated cut-off for treatable viremia (2000 IU/mL). Genotype D was

detected in 86% of patients. Hepatic fibrosis ≥F2 was detected in 72.7%,

52.9%, 57.5% and 18.9% in Groups I-IV, respectively (P < 0.0001). Except in

Group II with a trend for lower ≥F2 fibrosis (P = 0.067), there was no

significant difference by using HBV DNA cut-off 20 000 vs 2000 IU/mL.

Multivariate logistic regression analysis identified study Group IV (OR, 0.0276;

CI: 0.088-0.868; P = 0.0276) and milder (A0-1) necroinflammatory grade (OR,

0.135; CI: 0.063-0.287; P < 0.0001) as independent predictors of ≥F2

fibrosis. The specificity, positive and negative predictive values for PEALT in

detection of ≥F2 fibrosis for viremia ≥2000 IU/mL (80%, 69% and 65%,

respectively) or ≥20 000 IU/mL (86%, 73% and 63%, respectively) were

similar, with a marginal gain in sensitivity (51%vs 42%, respectively).

Significant fibrosis is prevalent in a large proportion of HBeAg-negative

patients with high viremia and persistently normal ALT. Lower HBV DNA cut-offs

could be adopted with marginal gains in fibrosis detection and without loss of

diagnostic accuracy.

© 2011 Blackwell Publishing Ltd.

PMID: 21692936 [PubMed - as supplied by publisher]

[Guest guest]

J Viral Hepat. 2011 Jul;18(7):e217-e225. doi: 10.1111/j.1365-2893.2011.01437.x.

Epub 2011 Mar 1.

Discriminant value of serum HBV DNA levels as predictors of liver fibrosis in

chronic hepatitis B.

Sanai FM, Helmy A, Bzeizi KI, Babatin MA, Al-Qahtani A, Al-Ashgar HA, Al-Mdani

AS, Al-Akwaa A, Almutharea S, Khan MQ, Alghamdi AS, Farah T, Al-Hamoudi W,

Saadeh M, Abdo AA.

Source

Department of Hepatobiliary Sciences, King Abdulaziz Medical City, Riyadh, KSA

Division of Gastroenterology, Department of Medicine, King Faisal Specialist

Hospital & Research Center, Riyadh, KSA Gastroenterology Department, Riyadh

Military Hospital, Riyadh, KSA Division of Gastroenterology, Department of

Medicine, King Fahad General Hospital, Jeddah, KSA Department of Molecular

Virology, Research Center, King Faisal Specialist Hospital & Research Center,

Riyadh, KSA Department of Medicine, King Abdulaziz Medical City, Al-Ahsa, KSA

Division of Gastroenterology, Department of Medicine, King Khalid University

Hospital, King Saud University, Riyadh, KSA Clinical Research Center, King

Abdullah International Medical Research Center, National Guard Health Affairs,

Riyadh, KSA Liver Disease Research Center, King Saud University, Riyadh, KSA.

Abstract

Summary.  Current guidelines recommend antiviral therapy in chronic hepatitis

B (HBV) patients with significant histological disease. We aimed to compare

histological fibrosis (METAVIR, ≥F2) in patients with HBV DNA

≥20 000 IU/mL vs≥2000 IU/mL and identify predictors of fibrosis. We

performed prospective liver biopsies on 203 HBeAg-negative patients in four

groups: Group I (n = 55): HBV DNA ≥20 000 IU/mL and persistently

elevated alanine aminotransferase (ALT) levels (PEALT; >40 U/L); Group II

(n = 34): HBV DNA ≥20 000 IU/mL and persistently normal ALT (PNALT);

Group III (n = 40): HBV DNA <20 000 IU/mL and PEALT; and Group IV

(n = 74): HBV DNA <20 000 IU/mL, and PNALT. We reanalysed all groups in

relation to updated cut-off for treatable viremia (2000 IU/mL). Genotype D was

detected in 86% of patients. Hepatic fibrosis ≥F2 was detected in 72.7%,

52.9%, 57.5% and 18.9% in Groups I-IV, respectively (P < 0.0001). Except in

Group II with a trend for lower ≥F2 fibrosis (P = 0.067), there was no

significant difference by using HBV DNA cut-off 20 000 vs 2000 IU/mL.

Multivariate logistic regression analysis identified study Group IV (OR, 0.0276;

CI: 0.088-0.868; P = 0.0276) and milder (A0-1) necroinflammatory grade (OR,

0.135; CI: 0.063-0.287; P < 0.0001) as independent predictors of ≥F2

fibrosis. The specificity, positive and negative predictive values for PEALT in

detection of ≥F2 fibrosis for viremia ≥2000 IU/mL (80%, 69% and 65%,

respectively) or ≥20 000 IU/mL (86%, 73% and 63%, respectively) were

similar, with a marginal gain in sensitivity (51%vs 42%, respectively).

Significant fibrosis is prevalent in a large proportion of HBeAg-negative

patients with high viremia and persistently normal ALT. Lower HBV DNA cut-offs

could be adopted with marginal gains in fibrosis detection and without loss of

diagnostic accuracy.

© 2011 Blackwell Publishing Ltd.

PMID: 21692936 [PubMed - as supplied by publisher]

[Guest guest]

J Viral Hepat. 2011 Jul;18(7):e217-e225. doi: 10.1111/j.1365-2893.2011.01437.x.

Epub 2011 Mar 1.

Discriminant value of serum HBV DNA levels as predictors of liver fibrosis in

chronic hepatitis B.

Sanai FM, Helmy A, Bzeizi KI, Babatin MA, Al-Qahtani A, Al-Ashgar HA, Al-Mdani

AS, Al-Akwaa A, Almutharea S, Khan MQ, Alghamdi AS, Farah T, Al-Hamoudi W,

Saadeh M, Abdo AA.

Source

Department of Hepatobiliary Sciences, King Abdulaziz Medical City, Riyadh, KSA

Division of Gastroenterology, Department of Medicine, King Faisal Specialist

Hospital & Research Center, Riyadh, KSA Gastroenterology Department, Riyadh

Military Hospital, Riyadh, KSA Division of Gastroenterology, Department of

Medicine, King Fahad General Hospital, Jeddah, KSA Department of Molecular

Virology, Research Center, King Faisal Specialist Hospital & Research Center,

Riyadh, KSA Department of Medicine, King Abdulaziz Medical City, Al-Ahsa, KSA

Division of Gastroenterology, Department of Medicine, King Khalid University

Hospital, King Saud University, Riyadh, KSA Clinical Research Center, King

Abdullah International Medical Research Center, National Guard Health Affairs,

Riyadh, KSA Liver Disease Research Center, King Saud University, Riyadh, KSA.

Abstract

Summary.  Current guidelines recommend antiviral therapy in chronic hepatitis

B (HBV) patients with significant histological disease. We aimed to compare

histological fibrosis (METAVIR, ≥F2) in patients with HBV DNA

≥20 000 IU/mL vs≥2000 IU/mL and identify predictors of fibrosis. We

performed prospective liver biopsies on 203 HBeAg-negative patients in four

groups: Group I (n = 55): HBV DNA ≥20 000 IU/mL and persistently

elevated alanine aminotransferase (ALT) levels (PEALT; >40 U/L); Group II

(n = 34): HBV DNA ≥20 000 IU/mL and persistently normal ALT (PNALT);

Group III (n = 40): HBV DNA <20 000 IU/mL and PEALT; and Group IV

(n = 74): HBV DNA <20 000 IU/mL, and PNALT. We reanalysed all groups in

relation to updated cut-off for treatable viremia (2000 IU/mL). Genotype D was

detected in 86% of patients. Hepatic fibrosis ≥F2 was detected in 72.7%,

52.9%, 57.5% and 18.9% in Groups I-IV, respectively (P < 0.0001). Except in

Group II with a trend for lower ≥F2 fibrosis (P = 0.067), there was no

significant difference by using HBV DNA cut-off 20 000 vs 2000 IU/mL.

Multivariate logistic regression analysis identified study Group IV (OR, 0.0276;

CI: 0.088-0.868; P = 0.0276) and milder (A0-1) necroinflammatory grade (OR,

0.135; CI: 0.063-0.287; P < 0.0001) as independent predictors of ≥F2

fibrosis. The specificity, positive and negative predictive values for PEALT in

detection of ≥F2 fibrosis for viremia ≥2000 IU/mL (80%, 69% and 65%,

respectively) or ≥20 000 IU/mL (86%, 73% and 63%, respectively) were

similar, with a marginal gain in sensitivity (51%vs 42%, respectively).

Significant fibrosis is prevalent in a large proportion of HBeAg-negative

patients with high viremia and persistently normal ALT. Lower HBV DNA cut-offs

could be adopted with marginal gains in fibrosis detection and without loss of

diagnostic accuracy.

© 2011 Blackwell Publishing Ltd.

PMID: 21692936 [PubMed - as supplied by publisher]