From the Guidelines
F3 fibrosis in hepatitis B represents a critical stage of liver disease that requires immediate antiviral therapy to prevent progression to cirrhosis and reduce the risk of hepatocellular carcinoma, as recommended by the most recent guidelines 1.
Definition and Classification
F3 fibrosis is classified as severe fibrosis or bridging fibrosis in the METAVIR scoring system, which ranges from F0 (no fibrosis) to F4 (cirrhosis). At this stage, the scar tissue has formed bridges between portal areas and central veins, significantly altering liver architecture.
Treatment and Management
Patients with F3 fibrosis typically require immediate antiviral therapy with medications like entecavir (0.5mg daily), tenofovir disoproxil fumarate (300mg daily), or tenofovir alafenamide (25mg daily) 1. These medications suppress viral replication, reduce inflammation, and may prevent further fibrosis progression or even allow some regression of fibrosis. Treatment is generally long-term, often lifelong, and requires regular monitoring of liver function, viral load, and fibrosis status every 3-6 months.
Risk of Progression and Complications
Without treatment, approximately 20-30% of patients with F3 fibrosis will progress to cirrhosis within 5 years, which carries risks of liver failure, portal hypertension, and hepatocellular carcinoma. The most recent guidelines recommend HCC surveillance with abdominal ultrasound every 6 months in patients with advanced fibrosis or cirrhosis, regardless of anti-HDV therapy 1.
Key Recommendations
- Immediate antiviral therapy is recommended for patients with F3 fibrosis to prevent progression to cirrhosis and reduce the risk of hepatocellular carcinoma 1.
- Regular monitoring of liver function, viral load, and fibrosis status is necessary to adjust treatment and prevent complications.
- HCC surveillance with abdominal ultrasound every 6 months is recommended for patients with advanced fibrosis or cirrhosis, regardless of anti-HDV therapy 1.
From the Research
Definition of F3 Fibrosis
- F3 fibrosis refers to a stage of liver fibrosis where there is significant scarring of the liver tissue, but not yet cirrhosis [(2,3,4)].
- It is a critical stage in the progression of liver disease, as it can lead to cirrhosis and other complications if left untreated 4.
Diagnosis of F3 Fibrosis
- F3 fibrosis can be diagnosed using non-invasive tests such as the Fibrosis-4 index (FIB4) [(2,5)].
- The FIB4 index is a serum-based marker of liver fibrosis that can be used to stage the disease [(2,5)].
- Other tests such as APRI and AST/ALT ratio can also be used to diagnose and stage liver fibrosis 5.
Clinical Implications of F3 Fibrosis
- F3 fibrosis is a significant predictor of liver-related mortality and morbidity 4.
- Patients with F3 fibrosis are at increased risk of developing cirrhosis, hepatocellular carcinoma, and other complications [(4,6)].
- Antiviral therapy can help to reduce the risk of progression to cirrhosis and other complications in patients with chronic hepatitis B and F3 fibrosis [(2,6)].