Interest FibroScan (R) and biochemical markers of liver fibrosis in Senegalese chronic hepatitis B patients with low-replicative viral

Background and objectives: Infection with Hepatitis B Virus (HBV) is the most common cause of acute and chronic liver desease all over the world. Patients with low viral load and normal transaminases have a lesser risk of progression to fibrosis. We evaluated the proportion of chronic HBV patients without cytolysis with a low viral replication, not responding to antiviral treatment criteria founded on international recommendations; but requiring treatment based of significant fibrosis at FibroScan (R). Patients and methods: This is a prospective cross-sectional study between March 2013 and November 2014 in three hospitals in the region of Thies. Chronic hepatitis B patients who were at least 18 years of age, with HBV DNA levels below 20 000 IU/ml, normal liver enzymes (alanine transaminase < 40 U/l), mono infected by HBV were included. Patients with HIV or HCV or HBV antiviral treatment were excluded. Fibroscan (R) was performed in all patients. The APRI and FIB-4 scores were calculated. Results: In total 395 patients were evaluated: 94 met the inclusion criteria (53% male). The mean value Fibroscan (R) was 5.64 +/- 1.72 kPa with 17 patients (18.08%) who had fibrosis > 7kPa. To exclude a significant fibrosis (FS < 7kPa), the APRI and FIB-4 scores had similar performance (sensitivity 11.1%, specificity 96.05%, PPV 40% and NPV 82%) and (sensitivity 11.11%, specificity 90.79%, PPV 22.22% and NPV 81.18%) respectively. Conclusion: Many patients infected with HBV with normal ALT and low viral load have active liver disease. Both biological scores FIB-4 and APRI are useful for distinguishing patients without significant fibrosis with a good negative predictive value> 81%.