The Role of Elastography in HBV: Assessing Liver Fibrosis

Hepatitis B virus (HBV) chronic infection affects approximately 250 million people worldwide. The outcome of the infection and disease results from the interplay between virus and host’s immune system, where the inability to achieve an effective control of the infection is associated with liver necro-inflammation and the progression of chronic hepatitis (CH). Therefore, the management of HBV carriers requires a timely identification of the patient with CH and liver disease staging. The diagnostic role of vibration-controlled transient elastography (VCTE) (also known as transient elastography, TE) has been largely investigated and proven to be a reliable noninvasive index of liver disease burden, combining both fibrosis and inflammation. TE is a reliable method to identify chronic hepatitis B (CHB) patients with advanced fibrosis or cirrhosis, provided that liver stiffness (LS) values are interpreted according to alanine aminotransferase (ALT) levels. In patients on antivirals, the biphasic pattern of LS decline results from the combined kinetics of necro-inflammation and fibrosis. Lower LS values achieved during antiviral therapy are associated with a lower risk of hepatocellular carcinoma (HCC) development, at least in Asian cohorts. Future studies should validate the finding in Western CHB patients and investigate whether the lack of a significant second-phase long-term decline of LS would predict a higher residual HCC risk.