Correspondence to letter to the editor on “Non-linear association between liver fibrosis scores and viral load in patients with chronic hepatitis B”

Gi-Ae Kim; Seung Won Choi; Young-Suk Lim

doi:10.3350/cmh.2024.0619

Correspondence

Clin Mol Hepatol. 2025; 31(1): e108-e109.

Published online: August 5, 2024

DOI: https://doi.org/10.3350/cmh.2024.0619

Correspondence to letter to the editor on “Non-linear association between liver fibrosis scores and viral load in patients with chronic hepatitis B”

Gi-Ae Kim^1,^*, Seung Won Choi^2,^*, Young-Suk Lim³

Corresponding author : Young-Suk Lim Department of Gastroenterology, Asan Medical Centre, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
Tel: +82-2-3010-5933, Fax: +82-2-485-5782, E-mail: limys@amc.seoul.kr

^*GA Kim and SW Choi contributed equally to this work and deserve co-first authorship.

Editor: Han Ah Lee, Chung-Ang University College of Medicine, Korea

Received August 1, 2024 Accepted August 4, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

See the Original "Presence of liver fibrosis in chronic hepatitis B patients with varying serum hepatitis B virus DNA levels: Letter to the editor on “Non-linear association between liver fibrosis scores and viral load in patients with chronic hepatitis B”" on page e27.

Keywords: Hepatitis B virus; Liver fibrosis; Hepatocellular carcinoma; Liver cancer

Dear Editor,

We appreciate the letter from Wang et al. [1] in response to our article [2]. The letter explored liver fibrosis by serum HBV DNA levels in treatment-naïve chronic hepatitis B (CHB) patients without significant alanine aminotransferase (ALT) elevation. It is a large, multi-center cohort study using liver biopsy results, and its findings support our previous study involving non-invasive liver fibrosis scores.

The study can find its significance in the use of biopsy results. They showed that patients with moderate HBV DNA of 6–7 log₁₀ IU/mL had the highest proportion of significant fibrosis, advanced fibrosis, and cirrhosis compared to the other viral load groups. The tendency was more prominent in hepatitis B e antigen-negative patients. It is in line with our study that showed a non-linear parabolic association between viral load and aspartate aminotransferase to platelet ratio index (APRI) and fibrosis-4 (FIB-4) scores [2]. Moderate viral loads of 6–7 log₁₀ IU/mL corresponded to the highest APRI and FIB-4 scores. It is very encouraging that the study using liver biopsy produced comparable findings to this study.

The risk of moderate HBV DNA levels in CHB patients without ALT elevation has been underappreciated, but recently many studies have demonstrated their association with unfavorable outcomes [3,4]. Recent studies involving liver biopsy showed moderate HBV viral load of 5–7 log₁₀ IU/mL was independently associated with significant liver inflammation and fibrosis [5-7]. Moderate viral loads were also associated with an increased risk of developing hepatocellular carcinoma (HCC) [3,4]. With the underlying mechanisms not being elucidated yet, there is great anticipation for related research.

Taken together, valuable insights are being offered regarding the moderate HBV viral load and its significance. The established knowledge regarding the association of HBV viral load with liver fibrosis and HCC risk is expected to enhance the strategy for antiviral treatment for non-cirrhotic CHB patients.

Correspondence to letter to the editor on “Non-linear association between liver fibrosis scores and viral load in patients with chronic hepatitis B”

FOOTNOTES

Abbreviations

REFERENCES