From the Guidelines
F3 fibrosis in hepatitis B requires immediate antiviral treatment with potent nucleos(t)ide analogues to prevent disease progression and improve quality of life. The primary goal of therapy is to suppress viral replication, reduce liver inflammation, and prevent complications such as cirrhosis and hepatocellular carcinoma (HCC) 1. Patients with F3 fibrosis should be treated with medications like entecavir (0.5 mg daily, or 1 mg daily for lamivudine-resistant cases) or tenofovir disoproxil fumarate (300 mg daily) or tenofovir alafenamide (25 mg daily), which have minimal side effects and high genetic barriers to resistance.
Key aspects of management include:
- Long-term, often lifelong, treatment to prevent viral rebound and hepatic flares
- Regular monitoring with liver function tests every 3-6 months, HBV DNA levels every 6-12 months, and periodic assessment of fibrosis through non-invasive methods like FibroScan
- Hepatocellular carcinoma screening with ultrasound every 6 months due to increased cancer risk
- Antiviral therapy to inhibit viral replication, reduce liver inflammation, and allow fibrosis regression in many patients, significantly decreasing the risk of progression to cirrhosis, liver failure, and hepatocellular carcinoma 1.
While the American Gastroenterological Association guideline on the role of elastography in evaluating liver fibrosis provides valuable insights into the management of patients with chronic hepatitis C post-sustained virologic response (SVR), its direct application to hepatitis B patients with F3 fibrosis is limited 1. Therefore, the primary focus should remain on initiating and maintaining effective antiviral therapy for hepatitis B patients with F3 fibrosis, as outlined in the EASL 2017 clinical practice guidelines on the management of hepatitis B virus infection 1.
From the Research
F3 Fibrosis in Hepatitis B
- F3 fibrosis is a significant stage of liver fibrosis, indicating advanced fibrosis but not yet cirrhosis 2, 3, 4, 5, 6.
- The diagnosis of F3 fibrosis is crucial in determining the need for antiviral treatment in patients with chronic hepatitis B (CHB) 2.
- Non-invasive imaging-based measurements, such as magnetic resonance elastography (MRE) and two-dimensional shear-wave elastography (2D-SWE), have been proposed for the quantitative assessment of liver fibrosis 2.
- MRE has been shown to significantly discriminate F2 from F0/1 fibrosis, and its performance for diagnosing significant fibrosis is better than that of serum-based indices such as FIB-4 and APRI 2.
- Transient elastography (TE) has also been used to monitor the changes in the severity of liver fibrosis in CHB patients on antiviral treatment, and its performance is comparable to that of MRE 3.
- Serum levels of hepatitis B surface antigen (HBsAg) have been shown to predict the severity of fibrosis in patients with E antigen-positive CHB, and a scoring system has been developed to determine the degree of fibrosis based on HBsAg levels and other variables 4.
- FibroTest® and TE have been validated as markers of occurrence of cirrhosis without complications, oesophageal varices, and severe complications in patients with CHB, and can be used to assess the long-term dynamics of fibrosis in patients with sustained virological response 5.
- Non-invasive blood- and imaging-based algorithms, including MRE, 2D-SWE, TE, and FibroTest®, have been incorporated into international guidelines for HBV management and can reliably stage disease in many cases, reducing the need for invasive liver biopsy 6.