Factors associated with hepatic fibrosis reversal after entecavir treatment in patients with chronic hepatitis B

  Background  Hepatitis B virus infection is an important cause of liver fibrosis and cirrhosis. Antiviral therapy with nucleoside/nucleotide analogues and in turn achieving sustained biochemical and virological responses can improve liver fibrosis, but liver fibrosis in some patients is still progressing. It is necessary to know whether there are factors affecting the reversal of liver fibrosis after antiviral treatment.

  Objective  To analyze the influencing factors for the regression of liver fibrosis in patients with hepatitis B during entecavir (ETV) antiviral treatment.

  Methods  This study was a further analysis of a prospective randomized double-blind placebo-controlled clinical study. Patients with chronic hepatitis B who were admitted to 14 hospitals from October 2013 to October 2014 were selected for primary treatment with ETV. The paired liver biopsies were performed at treatment baseline and the 72nd week. These individuals were divided into regression and non-regression groups according to whether they achieved regression of liver fibrosis (decrease in Ishak fibrosis score of F ≥ 1 point) after 72 weeks of treatment, and risk factors of hepatic fibrosis regression were screened by multivariable logistic regression.

  Results  Totally 357 patients who had paired liver biopsies were included in this analysis. The mean age was 42.4 ± 10.1 years, 246 patients (68.9%) were male, and 209 patients (58.5%) were positive for HBeAg. Of the 357 cases, 165 (46.2%) patients achieved regression of liver fibrosis and 192 cases (53.7%) did not achieve regression. Multivariable logistic regression analysis showed that the baseline LSM values (9.4-17.0 kPa OR=0.509, 95% CI: 0.301-0.860, P=0.012; ≥17.0 kPa, OR=0.472, 95% CI: 0.252-0.882, P=0.019) and PLT＞85 × 10⁹ L⁻¹ (OR=2.683, 95% CI: 1.068-6.742, P=0.036) were the independent factors associated with the regression of liver fibrosis. Nevertheless, age and HBV DNA level at treatment baseline had no impact on the regression of liver fibrosis.

  Conclusion  Liver fibrosis can be reversed by anti-HBV treatment, patients with lower LSM and higher PLT values at baseline are easy to achieve regression of fibrosis during ETV antiviral treatment.