Interest of Non-Invasive Markers (APRI, FIB-4) for Assessing Hepatic Fibrosis in Patients with Chronic Viral Hepatitis B without Cytolysis and with Low Viral Replication

Background and Objectives: The indication for treatment in HBsAg-positive patients with low viral load and normal transaminases requires an assessment of fibrosis. In resource-limited settings, free hepatic fibrosis evaluation tests can aid in therapeutic decision-making. Our study aims to demonstrate the utility of assessing hepatic fibrosis using non-invasive markers (APRI and FIB-4) in patients with chronic B viral hepatitis without cytolytic activity and low viral replication in our context. Patients and Methods: This is a retrospective cross-sectional study conducted between January 2018 and December 2021 at the University Hospital Center of Bouaké. Included were all patients aged ≥18 with normal transaminases (<40 IU/mL), low viral replication (<20,000 IU/mL), asymptomatic, and monoinfected with HBV. Patients with HIV or HCV co- infection or those who had received any antiviral treatment were excluded. FibroScan^® was performed on all patients. APRI and FIB-4 scores were cal- culated. The diagnostic performance of fibrosis markers was analyzed using the receiver operating curve (ROC) to compare them. Sensitivity, specificity, positive and negative predictive values, and the area under the curve (AUROC) were calculated for each marker with a 95% confidence interval. A p-value <0.05 was considered significant. Results: Our study included 241 patients, with a mean age of 36.19 years (±10.52 years) and a male predominance of 52%. The mean FibroScan^® value was 6.44 ± 2.3 kPa, and 68 patients (28.22%) had fibrosis >7 kPa. To exclude significant fibrosis (FS < 7 kPa), APRI and FIB-4 scores showed comparable performances, with sensitivity, specificity, positive predictive value, and negative predictive value of 90.17%, 36.76%, 78.39%, 59.52%, and 84.97%, 39.70%, 78.19%, 59.52%, respectively. We found a positive correlation between FibroScan and biological fibrosis scores, with coefficients of 0.34 for APRI and 0.24 for FIB-4 (p-value < 0.05). Biological fibrosis scores had moderate performance in detecting significant fibrosis with respective AUROCs of 0.668 and 0.752 for APRI and FIB-4. Conclusion: A significant proportion of HBV-infected patients with normal ALT and low viral load have active liver disease. Both FIB-4 and APRI biological scores are useful in identifying individuals without significant fibrosis with a good negative predictive value (>50%).