Poster Presentations

Session Title: VIRAL HEPATITIS - d) HEPATITIS B – CLINICAL (EXCEPT THERAPY)
Presentation Date: Apr 23, 2009

USEFULNESS OF FIBROTEST AND FIBROSCAN FOR THE DIAGNOSIS OF HBS AG INACTIVE CARRIAGE

M.N. Hilleret¹, A. Cheveau¹, J.C. Renversez², N. Sturm³, J.P. Zarski¹, V. Leroy^1
1Clinique Universitaire d'Hépatogastroentérologie, ²DBI, Pole Biologie, ³Laboratoire de Pathologie Cellulaire, CHU de Grenoble, Grenoble, France

The diagnosis of HBs Ag inactive carriage is based on low HBV DNA levels (without any validated viral load threshold), HBeAg negativity and persistent normal ALT. In absence of liver biopsy, this status can be difficult to distinguish from HBe Ag - hepatitis B. Utility of non invasive tests of fibrosis is not well documented.
Methods: 117 HBs Ag inactive carriers consecutively seen in our center between 2003 and 2007 were included. HBs Ag inactive carrier status was defined as follow : HBs Ag +, Hbe Ag -, Anti-Hbe +, ALT < N at least at three occasions within a minimal 6 month follow-up, HBV DNA lower than 4 000 UI/ml, anti-HCV and delta negative. They were compared to 174 patients seen during the same period with histologically proven Hbe Ag - chronic hepatitis B. For each patient both transient elastography (Fibroscan) and Fibrotest were performed.
Results: Inactive carriers were significantly younger (37 vs 41 years, p< 0.01) and had lower ALT serum levels (25UI/ml vs 89UI/ml; p< 0.0001), HBV DNA (346 vs 2620 UI/ml; p< 0.01), Fibrotest (0.15 vs 0.39; p< 0.001) and Fibroscan values (4.9 vs 8.6 Kpa ; p< 0.001) than chronic HBV patients.Fibrotest and Fibroscan were then compared between inactive carriers (excluding inactive cirrhosis) and patients with mild HbeAg - chronic hepatitis B (METAVIR F0/F1, N=87). Both Fibrotest and Fibroscan values were significantly lower in inactive carrier group : 0.15 vs 0.28 ; p < 0,0001 and 4.9 vs 8,1 Kpa; p< 0.03, respectively. In inactive carriers, Fibrotest indicated F0 (< 0.21) in 81.6% of cases. Among them, 95.6% had a Fibroscan score lower than 7 Kpa, confirming absence of significant fibrosis. In the 17 patients with Fibrotest > 0.21, 5 (29.4%) had Fibroscan higher than 7 Kpa. These patients had Fibrotest ranging from 0.23 to 0.33 and Fibroscan from 7.2 to 10.4Kpa, suggesting significant fibrosis. They were significantly older (50 vs 35 years, p< 0.03) than patients without fibrosis.
Conclusions: Fibrotest (indicating F0) has an excellent specificity for the diagnosis of HBs Ag inactive carriage and can be used as first line fibrosis marker.