Staging chronic hepatitis B into seven categories, defining inactive carriers and assessing treatment impact using a fibrosis biomarker (FibroTest®) and elastography (FibroScan®)

J Hepatol. 2014 Nov;61(5):994-1003. doi: 10.1016/j.jhep.2014.06.027. Epub 2014 Jul 10.


Background & 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), oesophageal 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 an inactive carrier based on normal FT and ActiTest® (normal-FT-AT). The third aim was to assess the long-term dynamics of fibrosis in patients with sustained virological response.

Methods: The 10-year updated individual data of 1434 patients were pooled from two prospective cohorts.

Results: Of the 1312 patients without a history of complications, varices had occurred after 10 years in 14 patients (F4.2, incidence of 1.7%, 95% CI [0.6-2.8]), and severe complications in 25 (F4.3 3.7% [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 FT-AT 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.

Conclusions: FibroTest® and TE identified three categories of cirrhosis with increasing morbidity. Normal FibroTest® and ActiTest® were better able to identify inactive hepatitis B carriers than the standard definition. Despite virological response, the overall incidence of cirrhosis increased, with a remaining 5.8% risk of HCC.

Keywords: Chronic hepatitis B; Cirrhosis complications; Elastography; FibroSure; FibroTest®; Fibrosis stages; Hepatocellular carcinoma; Prognostic factors; Progression of fibrosis in virological responders; Regression fibrosis; Surrogate markers.

MeSH terms

  • Adult
  • Biomarkers / blood
  • Carcinoma, Hepatocellular / etiology
  • Carrier State / blood
  • Carrier State / diagnosis
  • Cohort Studies
  • Disease Progression
  • Elasticity Imaging Techniques
  • Esophageal and Gastric Varices / etiology
  • Female
  • Hepatitis B, Chronic / classification*
  • Hepatitis B, Chronic / complications
  • Hepatitis B, Chronic / diagnosis
  • Humans
  • Liver Cirrhosis / blood
  • Liver Cirrhosis / diagnosis
  • Liver Neoplasms / etiology
  • Male
  • Prospective Studies
  • Viral Load


  • Biomarkers