Correspondence to letter to the editor on “Non-linear association between liver fibrosis scores and viral load in patients with chronic hepatitis B”
Article information
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.
Notes
Authors’ contribution
Drafting the article: GAK, SWC, and YSL; final approval of the version of the article to be published: GAK, SWC, and YSL.
Conflicts of Interest
Y-SL is an advisory board member of Gilead Sciences and receives investigator-initiated research funding from Gilead Sciences. All the other authors have no conflict of interest to declare.
Abbreviations
ALT
alanine aminotransferase
APRI
aspartate aminotransferase to platelet ratio index
CHB
chronic hepatitis B
FIB-4
fibrosis-4
HCC
hepatocellular carcinoma