Liver Stiffness Measurement and Biochemical Markers in Senegalese Chronic Hepatitis B Patients with Normal ALT and High Viral Load

Despite the high prevalence of chronic hepatitis B (CHB) in Africa, few studies have been performed among African patients. We sought to evaluate liver stiffness measurement by FibroScan® (LSM) and two biochemical scores (FibroTest®, Fibrometer®) to diagnose liver fibrosis in Senegalese CHB patients with HBV plasma DNA load ≥3.2 log(10) IU/mL and normal alanine aminotransferase (ALT) values.LSM and liver fibrosis biochemical markers were performed on 225 consecutive HBV infected Senegalese patients with high viral load. Patients with an LSM range between 7 and 13 kPa underwent liver biopsy (LB). Two experienced liver pathologists performed histological grading using Metavir and Ishak scoring.225 patients were evaluated (84% male) and LB was performed in 69 patients, showing F2 and F3 fibrosis in 17% and 10% respectively. In these patients with a 7-13 kPa range of LSM, accuracy for diagnosis of significant fibrosis according to LB was unsatisfactory for all non-invasive markers with AUROCs below 0.70. For patients with LSM values below 7 kPa, FibroTest® (FT), and Fibrometer® (FM) using the cut-offs recommended by the test promoters suggested a fibrosis in 18% of cases for FT (8% severe fibrosis) and 8% for FM. For patients with LSM values greater than 13 kPa, FT, FM suggested a possible fibrosis in 73% and 70%, respectively.In highly replicative HBV-infected African patients with normal ALT and LSM value below 13 kPa, FibroScan®, FibroTest® or Fibrometer® were unsuitable to predict the histological liver status of fibrosis

Values of parameters used to scoring FibroTest® and Fibrometer® in the 7 patients with LSM<7 kPa and FibroTest® METAVIR scoring stages ≥F3.

<p><u>Normal values</u>: PT (prothrombin time):>70%, TB (total bilirubin): <20 µmol/L, GGT<73 IU/L, Platelets:>150 Giga/L, HA (Hyaluronic acid) <100 µg/L, Urea: 3.3–8.3 mmol/L, A2M (Alpha-2 macroglobulin): 1.3–3 g/L, Hapto (Haptoglobin): 0.64–1.7 g/L, ApoA1 ( Apolipoprotein A1): 1.04–2.02 g/L, ALT: 72 IU/L, AST: 59 IU/L.</p

Flow chart.

<p>Flow chart.</p

Box plots of LSM, FibroTest® and Fibrometer® scores according METAVIR stages from Liver Biopsy.

<p>Box plots of LSM, FibroTest® and Fibrometer® scores according METAVIR stages from Liver Biopsy.</p

Results of FT, FM METAVIR scoring stages according to Liver Stiffness Measurement values.

<p>Results of FT, FM METAVIR scoring stages according to Liver Stiffness Measurement values.</p

LSM values for each FibroTest® and Fibrometer® stage of fibrosis.

<p>LSM values for each FibroTest® and Fibrometer® stage of fibrosis.</p

Main characteristics of the 225 patients with CHB.

<p>*mean±SD,</p><p>**Median [IQ1–IQ3],</p><p>***F1–F2 considered as ≥F2.</p