Evaluation of HBeAg-Negative Chronic Hepatitis B Patients Who Had Undergone Liver Biopsy in Accordance with the Guidelines

Objective: In HBeAg-negative patients who constitute most of the hepatitis B patients in our country, treatment decision is made according to biopsy result. Guidelines do not require biopsy in some patient groups and suggest the treatment decision with HBV DNA and alanine aminotransferase (ALT) level. Non-invasive fibrosis measurement tests can also be used to assess liver fibrosis status. In our study, we aimed to investigate fibrosis measurement tests' predictability of liver biopsy result which is an invasive procedure and to evaluate our patients in terms of guidelines and national treatment justification criteria. Methods: HBeAg-negative 25 patients who had undergone liver biopsy in our clinic were investigated retrospectively. Patients' demographic features, liver biopsy results, HBV DNA levels and treatment decisions were recorded. AST to Platelet Ratio Index (APRI) and Fibrosis-4 (FIB4) scores were calculated. The correlation between APRI and FIB4 scores and biopsy results was investigated. Patients whom treatment could not be started were evaluated for eligibility according to guidelines. Results: With the biopsy results, the treatment was started in 15 patients while 10 (40%) of the patients could not be treated according to the valid national reimbursement regulations. Six of these 10 patients were the patients with high HBV DNA and ALT levels. APRI scores did not correlate with biopsy Ishak histologic activity index and fibrosis scores (p=0.4, p=0.3). FIB4 scores were in correlation with biopsy Ishak HAI scores (p=0.03) but did not correlate with fibrosis scores (p=0.5). Conclusions: In our study, it was understood that 40% of the patients who had undergone biopsy were not able to start treatment, and some of these patients were recommended to be treated without the necessity of liver biopsy according to the guidelines. Fibrosis tests are insufficient to predict liver biopsy results. It is thought that they cannot help to reduce the need for liver biopsy.