The degree of
liver fibrosis in
chronic hepatitis B (CHB)
infection influences outcome and management. Existing data describing the long-term dynamic changes of
liver fibrosis are limited. This study aimed to evaluate the evolution of
liver fibrosis in CHB across a 10-year period. CHB patients with liver stiffness measurement (LSM) by transient elastography 10 years ago were recruited for follow-up LSM.
Fibrosis stages were classified according to EASL-ALEH guidelines.
Fibrosis progression/regression was arbitrarily defined as ≥1
fibrosis stage change from baseline. A total of 459
hepatitis B e antigen (
HBeAg)-negative patients (224 untreated, 235 treated with nucleos(t)ide analogues [
NAs]) were recruited. The mean age at baseline LSM was 41.7 ± 9.0 years (56.2% male). Over 10 years, the proportion of patients with advanced
fibrosis/
cirrhosis significantly reduced from 16.3% to 5.7% (P < 0.001).
Fibrosis progression and regression were observed in 8.7% and 37.5%, respectively. No treatment with
NAs (OR 2.259, 95% confidence interval [CI]: 1.032-4.945),
metabolic syndrome (OR 4.379, 95% CI: 1.128-16.999) and hepatic steatosis (OR 7.799, 95% CI: 2.271-26.776) was associated with
fibrosis progression. Liver stiffness decline demonstrated positive correlation with the time after
HBsAg seroclearance (r = -0.50, P < 0.001). Median liver stiffness was higher both at baseline (14.0 vs 6 kPa, P < 0.001) and 10 years (9.1 vs 4.9 kPa, P < 0.001) in patients with
cirrhosis-related complications/
hepatocellular carcinoma compared with those without. In conclusion, CHB-related
liver fibrosis changed dynamically across 10 years.
Metabolic syndrome and hepatic steatosis were associated with
fibrosis progression, while
antiviral therapy was associated with
fibrosis regression. Patients with
HBsAg seroclearance demonstrated time-dependent decline in liver stiffness.