1Assistance Publique Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière, Paris, France; University Pierre et Marie Curie (UPMC) Univ Paris 06, Paris, France; INSERM, UMR_S 938, Paris, France. Electronic address: firstname.lastname@example.org.
2University of Bordeaux, Bordeaux, France.
3BioPredictive, Paris, France.
4Service de Biochimie Métabolique, Groupe Hospitalier Pitié-Salpêtrière (GHPS), AP-HP Paris, France.
5Assistance Publique Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
BACKGROUND AND AIMS:
The first aim was to extend the validation of FibroTest (FT) and transient elastography (TE) as markers of occurrence of cirrhosis without complications (F4.1), esophageal varices (F4.2), and severe complications (F4.3) in patients with chronic hepatitis B (CHB). The second aim was to validate a previous definition of inactive carrier based on normal FT and ActiTest (normal-FTAT). The third aim was to assess the long-term dynamics of fibrosis in patients with sustained virological response.
The 10 years updated individual data of 1434 patients were pooled from two prospective cohorts.
Of the 1312 patients without a history of complications, varices had occurred at 10 years in 14 patients [F4.2, incidence of 1.7%(0.6-2.8)], and severe complications in 25 [3.7%,95% CI (1.8-5.7)], including hepatocellular carcinoma (HCC) in 21 [3.7%(1.5-5.8)]. Using Cox-multivariate analysis adjusted for treatment, viral load, HBeAg status and ALT, FT and TE were predictive of liver-complications [n=37;AUROC=0.83(0.71-0.90);P<0.0001] and [n=8/844;AUROC=0.82(0.72-0.89); P<0.0001] respectively. Normal-FTAT better identified patients with lower fibrosis progression than the ALT-based standard: 3/163(1.8%) vs. 16/181(8.8%;P=0.004) in the Paris cohort, and 5/195(2.6%) vs. 15/228 (6.6%;P=0.05) in the Bordeaux cohort. Of the 582 responders, 23 had complications [incidence 6.2%(3.2-9.1)] including 19 HCC [5.8%(2.6-9.0)] and 10 with varices [2.6% (0.8-4.4)]. Of the 138 responders with advanced fibrosis, only 31%(15-47%) had fibrosis regression.
FibroTest and TE identified three categories of cirrhosis with increasing morbidity. Normal FibroTest and ActiTest were better able to identify inactive B carriers than the standard definition. Despite virological response, the overall incidence of cirrhosis increased, with a remaining 5.8% risk of HCC.