Liver biopsy is frequently required in
HBeAg-negative disease to determine the stage of
fibrosis. It can be difficult to distinguish cohorts with undetectable
HBeAg who may have varying degrees of
fibrosis due to different stages of disease. We have assessed the utility of transient elastography (TE) to evaluate differences in
HBeAg-negative patients. A total of 220
HBsAg-positive individuals were studied: 125 (group 1) had an inactive
HBsAg carrier state and 95 (group 2) were
HBeAg-negative, anti-HBe-positive patients with persistently or intermittent elevation of
alanine aminotransferase (ALT) and/or HBV
DNA >10(5) copies/mL. Mean stiffness was 4.83 +/- 1.2 kPa in group 1 vs 8.53 +/- 6 kPa in group 2 (P < 0.001); statistically significant differences were also found between AST/ULN ALT/ULN ratios, HBV
DNA in group 1 vs group 2, respectively (P < 0.001). In the multivariate analysis, the only variable independently associated with the stage of
fibrosis was the stiffness. This study shows that mean hepatic stiffness by elastography is significantly lower in patients with inactive
hepatitis B compared to those with
HBeAg-negative disease. The procedure is a useful adjunct to diagnosis to confirm a clinical pattern of disease, and for more selective use of liver biopsy before considering
antiviral therapy.