Copyright
©The Author(s) 2015.
World J Gastroenterol. Nov 14, 2015; 21(42): 12141-12149
Published online Nov 14, 2015. doi: 10.3748/wjg.v21.i42.12141
Published online Nov 14, 2015. doi: 10.3748/wjg.v21.i42.12141
Phase of HBV infection | Immune-tolerant | Immune-active (-clearance) | Immune-inactive | Reactivation/HBeAg-negative chronic hepatitis |
HBsAg | Detectable | Detectable | Detectable | Detectable |
HBeAg | Detectable | Detectable | Undetectable (anti-HBe positive) | Undetectable (anti-HBe positive) |
HBV DNA (IU/mL)/(copies/mL) | > 20000/> 105 | > 20000/> 105 | < 2000/< 104 or undetectable | > 2000/> 104 |
ALT | Normal | Persistently elevated | Normal | Normal or elevated |
Histopathology: necroinflammation and fibrosis | Minimal or absent | Can develop | Liver inflammation absent or minimal, fibrosis regresses over time | Active liver inflammation +/- fibrosis |
Liver biopsy | Generally not indicated | Indicated | Generally not indicated | Indicated, especially if ALT elevated |
Antiviral therapy | Generally ineffective, risk of drug resistance; continued monitoring recommended | Should be considered | Continued monitoring recommended | Should be considered if moderate or severe inflammation or fibrosis detected |
Table 2 Liver biopsy findings in children with chronic hepatitis B and C n (%)
Type of infection | Patients (n) | Age,yr (mean ± SD or range) | Grading of necroinflammatory activity | Staging of fibrosis | Ref. | |||||
mean HAI ± SD | Minimal/mild | Moderate/severe | mean ± SD | No/low grade | Severe/cirrhosis | Cirrhosis | ||||
HBV | 30 | 12.9 ± 2.5 | 5.4 ± 3.4 | 25 (84) | 5 (16) | 1.7 ± 0.9 | 24 (80) | 6 (20) | 1 (3) | Pokorska-Śpiewak et al[52] |
HBV | 35 | 10.2 (2.0-20.2) | - | 33 (94) | 2 (6) | - | 28 (80) | 7 (20) | 2 (7) | Boxall et al[77] |
HBV | 190 | 7.5 ± 4.1 | 6.07 ± 3.22 | 135 (71) | 55 (29) | 1.71 ± 0.78 | 183 (96) | 7 (4) | 1 (0.5) | Mozer-Lisewska et al[30] |
HBV | 47 | 9 (1-17) | - | 34 (72) | 13 (28) | - | 41 (87) | 6 (13) | 0 | Dzierzanowska-Fangrat et al[78] |
HCV | 30 | 11.5 ± 3.6 | 4.2 ± 2.5 | 29 (97) | 1 (3) | 1.2 ± 0.9 | 28 (93) | 2 (7) | 0 | Pokorska-Śpiewak et al[52] |
HCV | 44 | 8.6 ± 4.1 | - | 32 (73) | 12 (27) | - | 39 (89) | 5 (11) | - | Mohan et al[43] |
HCV | 44 | 14.5 ± 4.0 | - | 33 (75) | 11 (25) | - | 35 (80) | 9 (20) | - | Mohan et al[43] |
HCV | 112 | 8.6 (1-19) | - | - | - | - | 107 (96) | 5 (4) | 1 (1) | Guido et al[79] |
HCV | 80 | 9.1 ± 4.8 | - | 62 (78) | 17 (21) | - | 66 (83) | 13 (16) | 1 (1) | Guido et al[80] |
HCV | 121 | 9.8 ± 3.7 | 5.1 | 72 (60) | 49 (40) | - | 114 (94) | 7 (6) | 2 (2) | Goodman et al[46] |
HCV | 42 | 13.4 ± 4.1 | - | 30 (71) | 12 (29) | - | 37 (88) | 5 (12) | - | Mohan et al[42] |
HCV | 109 | 8.8 ± 4.2 | 3.3 ± 1.5 | - | - | 1.36 ± 0.5 | 105 (97) | 4 (3) | - | Kage et al[81] |
HBV/HCV | 10 | 12.6 ± 2.7 | 6.2 ± 3.0 | 7 (70) | 3 (30) | 1.7 ± 0.8 | 9 (90) | 1 (10) | 0 | Pokorska-Śpiewak et al[52] |
Table 3 Indications for the antiviral treatment in patients with chronic hepatitis C according to the stage of fibrosis[45]
Stage of fibrosis (METAVIR) | Treatment |
Significant fibrosis (F3) or cirrhosis (F4), including decompensated cirrhosis | Should be prioritized |
Moderate fibrosis (F2) | Is justified |
No or mild liver disease (F0, F1) | Can be deferred |
Table 4 Diagnostic performance of the main non-invasive methods used to determine significant liver fibrosis (METAVIR F ≥ 2) and cirrhosis (METAVIR F4) in adult and pediatric patients
Test | Patients (n) | Disease | AUROC | Ref. | |
F≥2 | F4 | ||||
Fibrotest | 3501 | HCV | 0.85 | - | Poynard et al[82] |
Fibrotest | 1457 | HBV | 0.80 | - | Poynard et al[82] |
Fibrotest | 1161 | Chronic liver disease | - | 0.73 | de Lédinghen et al[69] |
APRI | 6259 | HCV | 0.77 | 0.83 | Lin et al[83] |
APRI | 1161 | Chronic liver disease | - | 0.73 | de Lédinghen et al[69] |
TE | 251 | HCV | 0.79 | 0.97 | Ziol et al[84] |
TE | 183 | HCV | 0.83 | 0.95 | Castéra et al[47] |
TE | 165 | HCV | 0.88 | 0.90 | Nitta et al[85] |
TE | 400 | HCV | 0.818 | 0.932 | Sporea et al[86] |
TE | 173 | HBV | 0.81 | 0.93 | Marcellin et al[87] |
TE | 175 | HBV | 0.95 | 0.98 | Zhu et al[88] |
TE | 1161 | Chronic liver disease | - | 0.88 | de Lédinghen et al[69] |
TE | 301 | HCV | 0.815 | 1.00 | Awad et al[89] |
ARFI | 911 | HCV | 0.792 | 0.842 | Sporea et al[86] |
- Citation: Pokorska-Śpiewak M, Kowalik-Mikołajewska B, Aniszewska M, Pluta M, Marczyńska M. Is liver biopsy still needed in children with chronic viral hepatitis? World J Gastroenterol 2015; 21(42): 12141-12149
- URL: https://www.wjgnet.com/1007-9327/full/v21/i42/12141.htm
- DOI: https://dx.doi.org/10.3748/wjg.v21.i42.12141