Evaluating the Role of Liver Biopsy in Asymptomatic HBV Carrier

Background: The association between HBV asymptomatic carrier and liver histology is not well recognized. It is not uncommon to witness cirrhosis, hepatic decompensation and HCC in patients with HBV surface antigen (HBsAg) positive. Objective: The main objective of this study is to determine the role of liver biopsy in asymptomatic HBV carrier to document the extent of liver damage. Place and Duration of Study: The study was conducted at PIMS (Department of Gastroenterology) from august 2006 to august 2008. Materials and Methods: It was a prospective study on outpatients with HBV asymptomatic carrier.The subjects with NASH/ NAFLD and history of treatment for CHB were excluded from study. All patients underwent liver biopsy using spinal needle 16Fr under local anaesthesia. Written informed consent was obtained.Prothrombin time and platelets counts were checked in every patient with in a week before procedure. Liver biopsy was done if baseline prothrombin time was no more than 3 seconds beyond control and platelets count was not less than 100x109/L.All patients were retained about 4 hours in hospital to observe any complication. The biopsies were scored using the modified HAI scoring system. Results: The numbers of enrolled patients were 60 with (age ranging between 15-55 years). 44(73.3%) male and 16(26.6%) were females. Of 6(10%) patients with significantHAI-F≥2/ 6, 4 have stage HAI-F2 and 2 have HAI-F4 and all were male. Almost all patients 58/60 had some degree of HAI-NI on histology. We observed that ALT level and gender strongly affect histology but age had poor correlation with histology. Conclusion: All patients with asymptomatic HBV carrier affected some degree of necroinflammation (HAI-NI) on histology significant number of patients also had advanced fibrosis. We recommend that assessment of liver biopsy specimens in a larger cohort of asymptomatic HBV carriers is necessary to establish management guidelines for such patients.