Liver fibrosis assessment in long-term therapy with nucleos(t)ide analogues in chronic hepatitis B


DOI: https://dx.doi.org/10.18565/therapy.2021.6.24-31

Panevkina S.V., Abdurakhmanov D.T., Ibragimov E.K., Rozina T.P., Nikulkina E.N., Tanaschuk E.L., Odintsov A.V., Moiseev S.V.

1) M.V. Lomonosov Moscow State University; 2) I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of Russia (Sechenov University)
Abstract. The aim of the study was to estimate the dynamics of liver fibrosis in chronic hepatitis B (CHB) patients during nucleos(t)ides analogues (AN) therapy.
Material and methods. The study included 101 patient with CHB (males – 80%, median age 39 years) who received AN therapy for ≥3 years (maximum 9 years) from 2008 to 2017. Liver density was estimated by transient fibroelastometry use before and during therapy. The severity of fibrosis was assessed using the METAVIR scale. In the course of treatment, the frequency of the virological response (DNA of the hepatitis B virus <150 IU/ml), normalization of ALT and AST activity, the degree of decrease of liver tissue density (according to the data of transient liver elastometry) were determined. The patients were divided into 2 groups: with a significant liver density decrease (≥20%) and without a significant decrease of that index (<20%). Independent factors associated with the absence of a significant liver density decrease were identified by means of binary logistic regression.
Results. In 98% of patients, a decrease in liver density was observed in average from 8,2 (7,4–10,1) to 6,7 (6,0–7,8) kPa (p <0,0001). The median of liver density decrease consisted 1,4 (1,1–2,2) kPa, or 17.5% (12,3–24,3). In more than half of the cases (57%), there was fixed a decrease in the severity of fibrosis by 1 or more points according to METAVIR scale. Liver density decrease was observed in all patients with initial liver cirrhosis (in 3 patients – a decrease of fibrosis stage according to METAVIR scale). During the study, the proportion of patients with fibrosis ≥F2 according to METAVIR decreased from 48% to 14% (p <0,0001). Patients who achieved a virologic response showed a greater decrease in liver density than patients who did not achieve this response (median: -1,4 and 1,0, respectively; p=0,023). Patients with a significant decrease in liver density (≥20%) initially had higher ALT activity and liver tissue density, and less often there was a development of resistance to therapy and virological breakthrough. A high initial index of liver tissue density (RR=1,96; 95% CI: 1,38–2,78; p <0,0001) came to be an independent predictor of a pronounced decrease in liver density during AN therapy.
Conclusion. Long-term treatment with AN leads to a decrease in liver fibrosis in most CHB patients, including those with liver cirrhosis.
Keywords: liver tissue density, nucleos(t)ide analogues, transient elastometry, chronic hepatitis B
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About the Autors

Sofia V. Panevkina, clinical resident of the Department of Iinernal medicine, faculty of fundamental medicine, M.V. Lomonosov Moscow State University. Address: 119192, Moscow, 27/1 Lomonosovsky Avenue. Tel.: +7 (977) 855-61-33. E-mail: panevkina.sophia@gmail.com
Dzhamal T. Abdurakhmanov, MD, professor of the Department of internal, occupational diseases and rheumatology, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of Russia (Sechenov University). Address: 119992, Moscow, 11/5 Rossolimo Str. Tel.: +7 (926) 280-34-31. E-mail: abdjamal@mail.ru
Elkhan K. Ibragimov, gastroenterologist-hepatologist, oncologist, post-graduate student of the Department of internal, occupational diseases and rheumatology, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of Russia (Sechenov University). Address: 119992, Moscow, 11/5 Rossolimo Str. E-mail: elhan8684@mail.ru
Teona P. Rozina, PhD, associate professor of the Department of internal, occupational diseases and rheumatology, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of Russia (Sechenov University), associate professor of the Department of internal diseases of the Faculty of fundamental medicine, M.V. Lomonosov Moscow State University. Address: 119992, Moscow, 11/5 Rossolimo Str. E-mail: alrozin@yandex.ru
Elena N. Nikulkina, assistant of the Department of internal, occupational diseases and rheumatology, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of Russia (Sechenov University). Address: 119992, Moscow, 11/5 Rossolimo Str. E-mail: nikulkene@mail.ru
Elena L. Tanashchuk, PhD, associate professor of the Department of Internal, occupational diseases and rheumatology, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of Russia (Sechenov University). Address: 119992, Moscow, 11/5 Rossolimo Str. E-mail: Elena_Tanaschuk@mail.ru
Alexey V. Odintsov, doctor of the clinic of rheumatology, nephrology and occupational pathology named after V.I. Tareev, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of Russia (Sechenov University). Address: 119992, Moscow, 11/5 Rossolimo Str. Email: alexeyodintsov@mail.ru
Sergey V. Moiseev, MD, professor, head of the Department of internal, occupational diseases and rheumatology, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of Russia (Sechenov University), professor of the Department of internal diseases of the Faculty of fundamental medicine, M.V. Lomonosov Moscow State University. Address: 119992, Moscow, 11/5 Rossolimo Str. E-mail: avt420034@gmail.com

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