Application of a Novel Algorithm in the Management of Chronic Hepatitis B Virus in Turkey: Efficacy of Non-Invasive Methods

Management of Chronic Hepatitis B

Abstract

Background: Liver biopsy has traditionally been regarded as the gold standard for staging and treatment decision-making in chronic hepatitis B (CHB). However, in recent years, non-invasive assessment tools have gained increasing recognition for their utility in evaluating disease severity and guiding therapeutic strategies. Following the enactment of the Health Implementation Communiqué (SUT) on November 2, 2024, the chronic hepatitis B treatment algorithm was substantially revised, incorporating non-invasive markers into the clinical decision-making framework.”This study aimed to evaluate the concordance of non-invasive indices, specifically APRI and FIB-4, with liver biopsy findings and to assess the potential impact of the updated SUT criteria on treatment eligibility.

Methods: A retrospective study was performed on 143 treatment-naïve patients with chronic hepatitis B who underwent percutaneous liver biopsy at the Infectious Diseases Clinic of Gaziantep City Hospital between October 2023 and January 2025. Demographic characteristics, laboratory parameters (ALT, AST, platelet count, HBV DNA), histopathological findings (histological activity index [HAI] and fibrosis stage), and non-invasive scores (APRI and FIB-4) were collected. Antiviral treatment indications were evaluated based on both prior and revised SUT criteria.

Results: Liver biopsy specimens were deemed insufficient in 5.6% (n=8) of patients. The mean HAI score was 5.24 ± 2.24, and the mean fibrosis stage was 1.56 ± 1.12. Fibrosis distribution revealed 14.8% (n=20) without fibrosis, 65.2% (n=88) with mild fibrosis (stage 1–2), 17.0% (n=23) with moderate fibrosis (stage 3–4), and 3.0% (n=4) with advanced fibrosis (stage ≥5). Based on biopsy results, 53.8% of patients (n=77) received antiviral therapy. According to the new SUT criteria, 35 patients aged >40 years with HBV DNA >20,000 IU/mL, 12 patients with APRI >0.5, and 11 patients with FIB-4 >1.45 were identified. Application of the revised algorithm would increase the number of patients eligible for treatment from 77 to 98.

Conclusion: These findings suggest that non-invasive indices, including APRI and FIB-4, can serve as valuable adjuncts—or, in select cases, alternatives—to liver biopsy in the clinical management of CHB. Implementation of the revised SUT criteria may substantially expand the pool of patients indicated for antiviral therapy, facilitating earlier intervention in individuals at risk for fibrosis progression. Wider adoption of non-invasive assessment methods in routine practice has the potential to minimize the risks associated with invasive liver biopsy while improving timely access to therapy, thereby enhancing the efficiency and effectiveness of CHB management. Prospective, large-scale studies are warranted to further delineate the role of non-invasive markers in clinical decision-making algorithms.