Recent studies have found that antiviral therapy can reverse liver fibrosis or even early cirrhosis caused by hepatitis B virus. However, they have mostly focused on the severity of, but not the dynamic changes in, fibrosis. The authors propose a new classification to evaluate these dynamic changes in the quality of fibrosis: predominantly progressive (thick/broad/loose/pale septa with inflammation), predominately regressive (delicate/thin/dense/splitting septa), and indeterminate. These represent an overall balance between progressive and regressive scarring. The authors then used this classification to evaluate 71 paired liver biopsies of chronic hepatitis B patients before and after entecavir-based therapy for 78 weeks. They found that progressive, indeterminate and regressive were observed in 58%, 29% and 13% of patients before treatment versus in 11%, 11% and 78% after treatment, respectively. Of the patients who showed predominantly regressive changes upon post-treatment liver biopsy, 53% still had fibrosis improvement of at least one Ishak stage and 45% displayed significant improvements in terms of Laennec substage, collagen percentage area and liver stiffness despite remaining in the same Ishak stage.
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