Correlation between Transient Elastography and Liver Biopsy in Chronic Hepatitis B Patients with Elevated HBV DNA and Normal Alanine Aminotransferase Level

Background: Chronic hepatitis B (CHB) is a significant global health burden, Patients with CHB are at increased risk of developing cirrhosis, liver failure and hepatocellular carcinoma (HCC). Even in asymptomatic state, there may be much progression of necroinflammation and fibrosis in liver in many patients specially in patients with elevated HBV DNA with normal alanine aminotransferase. Liver biopsy is the gold standard for fibrosis evaluation but has limitations, necessitating non-invasive alternatives like transient elastography in CHB patients with elevated DNA and normal ALT. Objective: This study aims to assess the correlation between TE and liver biopsy findings in CHB patients with elevated HBV DNA and normal ALT, evaluating TE's diagnostic accuracy in detecting significant fibrosis. Methodology: A cross-sectional study was conducted at the Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, from June 2019 to February 2020. Forty CHB patients (HBsAg positive >6 months, ALT <40 IU/L, HBV DNA >2,000 IU/mL) underwent TE and percutaneous liver biopsy. Fibrosis stages were evaluated using the METAVIR scoring system. TE findings were correlated with histological fibrosis using Pearson's correlation test, with statistical analysis performed via SPSS version 23. Results: The mean age of patients was 30.20 ± 8.3 years, with a male predominance (75%). TE classified 77.5% of patients as having F0-F1 fibrosis and 22.5% as F2 fibrosis. Histological analysis identified 57.5% with F0-F1 fibrosis and 42.5% with significant fibrosis (F2-F4). TE and biopsy findings showed a positive correlation (p<0.001). The receiver-operating characteristic (ROC) curve for TE demonstrated an area under the curve (AUC) of 0.774, with a cut-off value of 5.9 kPa yielding a sensitivity of 70% and specificity of 91% for detecting significant fibrosis. Conclusion: TE shows a strong correlation with liver biopsy findings in CHB patients with elevated HBV DNA and normal ALT, demonstrating its potential as a reliable, non-invasive alternative for fibrosis assessment. Utilizing TE in clinical settings could enhance early detection and management of liver fibrosis, reducing the need for invasive biopsies.