Factors Associated with Progressive Liver Disease in Untreated HBV Patients in Tunisia.

Q2 Pharmacology, Toxicology and Pharmaceutics

F1000Research Pub Date : 2025-08-27 eCollection Date: 2025-01-01 DOI:10.12688/f1000research.157075.3

Sana Rouis, Soumaya Mrabet, Mohamed Ferjaoui, Nedia Ben Lasfar, Jihene Sahli, Syrine Boujamline, Rym Ayari, Maha Abid, Manel Ben Selma, Mariem Ben Ticha, Foued Bellazreg, Elhem Ben Jezia, Amel Letaief, Wissem Hachfi

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引用次数: 0

Abstract

Background: Antiviral therapy is not routinely recommended for chronic hepatitis B virus (HBV) infection in patients with elevated serum HBV DNA levels (>2000 IU/mL), normal alanine aminotransferase (ALT) levels, and no significant liver fibrosis, referred to as the "indeterminate phase." This study aimed to identify factors associated with liver fibrosis progression in chronic HBV patients within this phase. Since the study's design, hepatitis B treatment guidelines have undergone significant evolution. New WHO recommendations published in 2024 advocate for expanded treatment criteria, making terms like "Indeterminate phase" obsolete.

Methods: This retrospective longitudinal cohort study was conducted at Farhat Hached University Hospital in Sousse, Tunisia, from January 2008 to January 2022. We included HBsAg-positive patients who were untreated, had a viral load >2,000 IU/mL for at least six months, normal ALT (<40 IU/L), and a fibrosis score of F0 and/or F1 (determined by liver biopsy or FibroScan). Univariate and logistic regression analyses were performed to identify factors associated with liver fibrosis progression.

Results: A total of 97 patients were included, with a median age of 32.9 ± 9.1 years and a female predominance (M/F ratio = 0.64). Fibrosis progression occurred in 16 patients (16.5%), with a mean delay of 70.9 ± 41.1 months. Univariate analysis showed significant associations between fibrosis progression and comorbidities (p = 0.001), high initial viral load (p = 0.004), elevated liver enzymes (p = 0.001), and increased viral load during follow-up (p = 0.002). Multivariate analysis identified comorbidities (p<0.001) and changes in ALT levels (p<0.001) as independent predictors of fibrosis progression.

Conclusion: Comorbidities and changes in ALT levels during follow-up were associated with fibrosis progression in the indeterminate phase of chronic HBV infection. Our findings support recent changes in international guidelines, including those from the WHO in 2024, which expand therapeutic indications for individuals living with hepatitis B.

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突尼斯未经治疗的HBV患者进展性肝病相关因素

背景：慢性乙型肝炎病毒（HBV）感染患者血清HBV DNA水平升高（>2000 IU/mL），谷丙转氨酶（ALT）水平正常，无明显肝纤维化（称为“不确定期”），抗病毒治疗不被常规推荐。本研究旨在确定慢性HBV患者肝纤维化进展的相关因素。自该研究设计以来，乙肝治疗指南发生了重大变化。世卫组织于2024年发布的新建议主张扩大治疗标准，使“不确定阶段”等术语过时。方法：本回顾性纵向队列研究于2008年1月至2022年1月在突尼斯苏塞Farhat Hached大学医院进行。我们纳入了未经治疗的hbsag阳性患者，病毒载量至少为2000 IU/mL 6个月，ALT正常(结果：共纳入97例患者，中位年龄为32.9±9.1岁，女性为主（M/F比= 0.64）。16例（16.5%）患者发生纤维化进展，平均延迟70.9±41.1个月。单因素分析显示，纤维化进展与合并症（p = 0.001）、高初始病毒载量（p = 0.004）、肝酶升高（p = 0.001）和随访期间病毒载量增加（p = 0.002）之间存在显著关联。结论：随访期间的合并症和ALT水平变化与慢性HBV感染不确定期的纤维化进展相关。我们的研究结果支持最近国际指南的变化，包括世界卫生组织在2024年的指南，扩大了乙型肝炎患者的治疗指征。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

F1000Research Pharmacology, Toxicology and Pharmaceutics-Pharmacology, Toxicology and Pharmaceutics (all)

CiteScore

5.00

自引率

0.00%

发文量

1646

审稿时长

1 weeks

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