Diagnostic Dilemma for Low Viremia with Significant Fibrosis; is Hepatitis B Virus DNA Threshold Level a Good Indicator for Predicting Liver Damage?

Abstract

Background: The most important difficulties about management ofhepatitis B are still determining the liver damage and the right time tostart antiviral therapy.Aims: To reveal the role of hepatitis B virus DNA threshold level forprediction of liver fibrosis and inflammation in young-aged hepatitisB e-antigen negative chronic hepatitis B patients.Study Design: Diagnostic accuracy study.Methods: A total of 273 hepatitis B e-antigen negative young chronichepatitis B patients with any hepatitis B virus DNA levels between2008 and 2016, who had liver biopsy after at least 6 months followup period, enrolled in this retrospective study. We created two groupsas case and control, cases with hepatitis B virus DNA levels below2000 IU/mL and controls with hepatitis B virus DNA levels over 2000IU/mL. Having histological activity index ≥4 or/and fibrosis scores≥2 were defined as significant histological abnormality. Then, weanalyzed the relationship between these groups.Results: We showed that significant fibrosis may occur in one third ofyoung chronic hepatitis B patients with low viremia (30.2%, n=42/139in cases, 55.2%, n=74/134 in controls). Among the 42 cases with lowviremia and significant fibrosis, 21.4% had alanine aminotransferaselevel between 40-59 U/L, 42.8% had alanine aminotransferase levelbetween 60-79 U/L, and 35.7% had alanine aminotransferase levelover 80 U/L. There was weak correlation between hepatitis B virusDNA threshold level and fibrosis score (p