hbv: non-invasive markers and usefulness of...

HBV: Non-invasive markers and usefulness of FibroScan

Álvaro MenaHIV and Hepatitis Unit. Internal Medicine [email protected]

Non invasive markers of liver fibrosis

• Serum markers:– Directs: deposition or removal of the extracellular

matrix.• Glycoproteins: serum hyaluronate, laminin and YKL-40.

• Collagens: procollagen III N-peptide, type IV collagen.

• Matrix metalloproteases.

– Indirects:• APRI: platelets, AST.

• FORNS: platelets, cholesterol, GGT.

• FIB-4: AST, ALT, platelets.

• FibroTest: α2 macroglobulin, haptoglobin, GGT, bilirubin, ApoA1.

• Cut-off <3: F2-F4 could be excluded: NPV 90.9%, PPV 64.7%, S 98%.

– Significative fibrosis: Cut-off >0.5: S 84%, Sp 41%. Cut-off >1.5: S 49%, Sp 84%.

– Cirrhosis: Cut-off >2: S 28%, Sp 87%.

• APRI show limited value in identifying hepatitis B related significant fibrosis and cirrhosis.

HEPATOLOGY 2005;42:1437-1445

• Zeng Score:– -13.995 + 3.220 log (α2-macroglobulin) + 3.096

log (age) 2.254 log (GGT) + 2.437 log (HA).

– Cut-off <3: F2-F4 could be excluded: NPV 90.9%, PPV 64.7%, S 98%.

– Cut-off >8.7: F2-F4 could be identified: PPV 84.8%, NPV 52.4%, Sp 90.4%.

– AgHBe+, Chinese, non- routine parameters.

Non invasive markers of liver fibrosis

• Transient elastography

• Magnetic resonance

Non-invasive markers: Ins & outs

Liver Int. 2014 Feb;34 Suppl 1:91-6.

Transient elastography

• Assessing the stage of fibrosis.

• Deciding to provide or defer therapy.

• Monitoring treatment response.

• Prediction of liver descompensations.

Transient elastography. Cut-offs

Aliment Pharmacol Ther 2011;34:353-362

Provide or defer therapy. Inactive carriers.

• AgHBs+, AcHBe+, AgHBe-.

• PNALT.

• DNA-HBV <2.000 IU/ml (<20.000 IU/ml).

• Follow-up >1 year

J Hepatol 2012;57:196-202

Persistently normal ALT: PNALT

J Hepatol 2012;57:196-202

•Meta-analysis, 6 studies, 246 patients.

•215 patients DNA-HBV<20.000 IU/ml:

•Fibrosis: moderate 4,5%, severe 0,5%.

•DNA-HBV >2.000 IU/ml and <20.000 IU/ml:

•10% fibrosis ≥moderate. Low necroinflammatory activity.

•DNA-HBV <2.000 IU/ml: 2,5% fibrosis ≥ moderate.

Journal of Gastroenterology and Hepatology 29 (2014) 173–178

•There are few data with patients complying the inactive carrier definition of the EASL, AASLD and APASL.•We aimed:

• To evaluate the LSM with FibroScan in real inactive CHB carriers. • Determinate the prevalence of significant fibrosis and probable cirrhosis in our population.• Investigate the relationship with virological, epidemiological, and metabolic factors.

Methods

• Cross-sectional cohort study.

• Excluded patients with other hepatic comorbilities.

• Follow-up>2 years.

• Inactive carriers. DNA-HBV <2000 IU/ml.

• Clinical, ultrasonographic and laboratory evaluations.

• Significant fibrosis (≥ F2) was considered if LSM was > 7.5 kPa, and probable cirrhosis > 11.8 kPa.

Conclusions

• 25% significant fibrosis and 7% probable cirrhosis.

• CHB influences less y fibrosis development than metabolic disturbances in true inactive carriers.

• 24% MS (15-34% Spanish populations), steatosis >90%.

• Limitations.

• Impact of treatment?

•Normal ALT: LSM<6 Kpa exclude F3-F4 and LSM >9 KPa confirm.

•ALT>x5: LSM< 7.5 exclude F3-F4 and LSM>13.5 Kpa confirm.

Conclusions

• Limited value of serum markers in HBV infection.

• FS is useful assessing the stage of fibrosis. Elevated ALT.

• What is an inactive carrier?

• Not only HBV and not only liver in hepatic fibrosis development.

• FS can predict liver decompensations.

…Thank you

hbv: non-invasive markers and usefulness of...

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