Compared to Caucasians, Africans have significantly higher rates of fibrosis and cirrhosis despite lower levels of HBV replication

It is believed that low HBV replication (<105 copies/ml) is indicative of mild histological lesions. In this study, French researchers aimed to assess the relationship between viral replication, histological lesions and race in HBV patients of diverse ethnic backgrounds.

The study group consisted of 552 chronic HBsAg carriers without other viral co-infection who had a liver biopsy. Viral replication was assessed in 516 patients by hybridisation and/or PCR assays.

Race was defined as African (Af, Blacks), Caucasian (Cc, Whites), Asian (As). Overall, Af had more frequent low viral replication (75%) than Cc (43%) or As (34%) (p<10-3). Despite low viral replication, 20% of patients had significant fibrosis (F2F3F4), including 7.5% with cirrhosis.

Among all patients with F2F3F4, 35% had low level replication and 16% no replication (<200 copies/ml). A third of cirrhotic patients had a low level of replication and 11% no replication.

The interactions between viral replication and liver lesions were also modified by race. In F2F3F4 patients, the proportion of those with low viral replication was 49% in Af, which was significantly higher than in As (25%, p<0.02) or Cc (26%, p=0.03). Non-Af race was associated with F2F3F4 (p=0.01) independent of male sex (p<10-3) and age (p<10-3). However, after adjustment for the level of viral replication the race effect disappeared.

The authors conclude: “A significant proportion of patients with chronic hepatitis B have advanced fibrosis despite a low level of HBV replication. Differences between Af and As patients suggest a considerable clinical impact of different HBV genotypes.”


Ratziu V et al. Low HBV replication and liver fibrosis: the impact of race in a study of 552 chronic hepatitis B patients. Abstract 440. 39th EASL, 14-18April 2004, Berlin, Germany.

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