The long-term prognosis and the need for histologic assessment in chronic hepatitis B in serological immune-tolerant phase

Yoo, Jeong-Ju; Park, Soo Young; Moon, Ji Eun; Lee, Yu Rim; Lee, Han Ah; Lee, Jieun; Kim, Young Seok; Seo, Yeon Seok; Kim, Sang Gyune

doi:.0.0.0

Original Article

The long-term prognosis and the need for histologic assessment in chronic hepatitis B in serological immune-tolerant phase

Jeong-Ju Yoo¹, Soo Young Park², Ji Eun Moon³, Yu Rim Lee², Han Ah Lee⁴, Jieun Lee⁵, Young Seok Kim¹, Yeon Seok Seo⁶

, Sang Gyune Kim¹

¹Division of Gastroenterology and Hepatology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
²Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
³Department of Biostatistics, Clinical Trial Center, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
⁴Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
⁵College of Medicine, Soonchunhyang University, Cheonan, Korea
⁶Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea

Correspondence :

Yeon Seok Seo ,
Tel: +82-2-920-6608, Fax: +82-2-953-1943, Email: drseo@korea.ac.kr
Sang Gyune Kim ,
Tel: +82-32-621-5215, Fax: +82-32-621-6079, Email: mcnulty@schmc.ac.kr

Received: October 19, 2022 Revised: November 30, 2022 Accepted: January 3, 2023

ABSTRACT

Background/Aims
The effect of histologic status of immune-tolerant (IT) phase of chronic hepatitis B on long-term outcomes is yet unclear. The aim of this study is to find out how well serological criteria currently used corresponds to the histologic criteria in determining IT phase and to suggest the indication for liver biopsy.
Methods
Patients in serological IT phase, defined by criteria of positive hepatitis B e antigen, HBV-DNA ≥ 106 IU/mL and normal or minimally elevated alanine aminotransferase (ALT) ≤ 60 IU/L, who underwent liver biopsy at three different hospitals were included. The distribution of histologic IT phase, defined as fibrosis of stage 1 or less and inflammation of grade 1 or less, was compared with that of serological IT phase. The risk factors for the incidence of liver-related events, such as hepatocellular carcinoma, liver cirrhosis, liver transplantation and death, were also analyzed.
Results
Eighty-two (31.7%) out of 259 clinically suspected IT phase patients belonged to histologic IT phase. Age over 35, high AST and low albumin were useful for ruling out histologic IT phase. Risk factors predicting liver-related events were age and significant fibrosis stage. There was no significant difference in the proportion of histologic IT phase and clinical prognosis between normal ALT and mildly elevated ALT groups. However, even in patients with normal ALT, age was an important factor in predicting the presence of histologic IT phase.
Conclusions
A significant number of patients who belonged to serological IT phase were not in histologic IT phase. Patients over 35 years and those with high AST, low albumin and low HBV DNA levels were more likely to experience poor long-term clinical outcomes. Therefore, additional histologic assessment should be considered.

KeyWords: fibrosis; biopsy; hepatitis B virus