Assessment of noninvasive liver stiffness in inactive HBsAg carriers by transient elastography

Background: Chronic viral hepatitis can be evaluated using invasive or noninvasive methods. Objectives: The aim of this study was to evaluate liver stiffness in inactive HBsAg carriers compared with normal subjects and determine if it is influenced by viral load in these patients. Patients and Methods: We prospectively evaluated 140 inactive HBsAg carriers and 152 normal subjects (without any signs or history of liver disease). In all subjects, liver stiffness was measured by 3 experienced physicians using a FibroScan® device (EchoSens, France) per standard procedures. We excluded patients for whom the SR of liver stiffness measurements was < 60% and those who had measurements with an IQR >30%. Results: The mean liver stiffness in inactive HBsAg carriers was 5.6±2.1kPa, significantly higher than in normal subjects (4.8 ± 1.2 kPa, p = 0.0002). In 16.4% (23) of inactive carriers, liver stiffness exceeded 7 kPa (the cutoff for significant fibrosis F ≥ 2). In patients with undetectable viral loads, the mean liver stiffness was 4.9 ± 1.2 kPa, significantly lower than in those with detectable DNA (< 2000 IU/ml) (6.7 ± 2.7 kPa, p < 0.001). Conclusions: Inactive HBsAg carriers have higher liver stiffness values compared with healthy individuals. Liver stiffness in inactive HBsAg carriers with detectable viral loads is higher than in those who are aviremic, suggesting that low viral loads promote fibrosis.