Role of Liver Biopsy in HBV Infected Egyptian Patients: A New Insight

Background: In chronic hepatitis B (HBV) Egyptian patients; international guidelines showed a wide discrepancy in validity of liver biopsy as a prerequisite to solve the dilemma of whether to start treatment or not.

Aim: Evaluating role of liver biopsy in deciding to treat or not Egyptian patients with chronic HBV irrespective of HBV-DNA and/or ALT levels.

Methods: This prospective study was carried out on four equal groups of chronic HBV Egyptian patients, selected from viral hepatitis clinic, National Liver Institute, Menofia University. They were classified according to their HBV DNA and ALT levels. All patients were HBsAg positive for at least 6 months, detectable HBV-DNA by PCR, with no prior submission for antiviral regimens. Liver biopsy was performed and analyzed according to Metavir scoring systems.

Results: Patients were 32.2 years old with 87.3% male prevalence. 88% of patients were HBeAg negative with 22% showing significant pathology {fibrosis (F) ≥2 and/or necroinflamatory activity (A) ≥2}. Patients eligible for treatment according to EASL 2009 guidelines were 39%, decreased to 29% with implementation of high ALT versus 22% when treatment decision was based on liver biopsy. While only 10.7% were eligible for treatment according to ASSLD 2009 guidelines, decreased to 4.3% with implementation of high ALT levels versus 22.3% when treatment decision was based on liver biopsy findings.

Conclusion: In spite of the discrepancy between treatment indications using either EASL 2009 or ASSLD 2009 guidelines, liver biopsy was more reliable in deciding which chronic HBV Egyptian patients to be treated, irrespective of HBV-DNA and/ or ALT level.