Determinants for persistent fibrosis during nucleoside analogue therapy in chronic hepatitis B

Abstract

BACKGROUND: Changes in liver stiffness measurements (LSM) during long-term nucleoside analogue therapy in chronic hepatitis B (CHB) have not been well-investigated. METHODS: We recruited CHB patients on long-term nucleoside analogue therapy with persistent virologic suppression (HBV DNA20 IU/mL on 3 occasions of at least 6 months apart) and with previous LSM indicating significant liver fibrosis, as defined by EASL-ALEH Guidelines ([9.0 kPa for normal alanine aminotransferase [ALT] and[12.0 kPa for ALT[1–5 9 upper limit of normal). Assessment included anthropometric measurements, HBV virology, and reassessment transient elastography and controlled attenuation parameter (CAP) measurements by FibroScan (Echosens, Paris, France). Hepatic steatosis was defined as CAP C222 dB/m. RESULTS: In this interim analysis, 119 CHB patients (77.3 % male) were recruited. Mean age at reassessment and mean duration of nucleoside analogue therapy was 56.1 (±10.4) years and 8.5 (±3.1) years, respectively. 38 patients (31.9 %) had persistent liver fibrosis. Patients with persistent liver fibrosis, when compared to patients with fibrosis reversal, had a significantly higher mean body-mass index (26.0 and 23.6 kg/m2, respectively, p = 0.040), mean systolic blood pressure (144 and 136 mmHg, respectively, p = 0.029) and mean diastolic blood pressure (82 and 77 mmHg, respectively, p = 0.046). There was no significant difference in the presence of hepatic steatosis among the two groups (65.8 % and 55.6 % respectively, p = 0.290). CONCLUSION: Metabolic parameters, including body-mass index and blood pressure, could influence fibrosis reversibility during long-term nucleoside analogue therapy. Recruitment is ongoing and the influence of other metabolic parameters (e.g. metabolic syndrome) will be analyzed.