[en] Objectives: the main objective of this study is to determinate the prevalence of significant fibrosis and probable cirrhosis measured by hepatic elastometry (HE), and to analyze the factors associated with fibrosis development. It has been carried in chronic HBV (CHB) infected patients classified as inactive carriers, non inactive carriers (treated or not) and HIV-coinfected. Secondary objectives were: evaluate the effect of antiviral treatment in liver fibrosis, analyze the fibrosis progression and compare the utility of HE with APRI and FIB-4 index to determinate the liver fibrosis in CHB infected patients mono and HIV-coinfected. Method: observational, prospective, open study including 221 patients with CHB followed in the University Hospital of A Coruña between May-2010 and June-2014. Basal HE was performed and during the follow up. Epidemiological and laboratory parameters were collected in a database. Univariate and multivariated adjusted logistic regression analyses were performed to explore factors associated with significant fibrosis and probable cirrhosis. A correlation and concordance analyses were used to compare HE with APRI and FIB-4. Results: the prevalence of significant fibrosis in inactive carriers was 25.0%, in untreated CHB (non inactive carriers) 44.4%, treated HCV patients 47.7% and HIVcoinfected 57.4%. In inactive carriers, metabolic factors were related with significant fibrosis and probable cirrhosis. In untreated patients with DNA-HBV >2,000UI/mL, HBV viral load and elevated transaminases were the related factors. In HBV treated patients and HIV-coinfected, metabolic factors, presence of HBeAg+ and HDV coinfection were the associated factors. After 24 months of follow-up, the fibrosis progressed in 6.6% of inactive carriers and 22.2% of untreated patients. Regression of fibrosis was observed in 14.3% of CHB treated patients and 9.6% of treated HIV-coinfected patients. Correlation coefficient was r=0.614 between HE and APRI and r=0.642 between HE and FIB-4. Conclusions: HE has proved useful to characterize and to measure the fibrosis in CHB infected patients mono and HIV-coinfected. In addition to viral factors associated with fibrosis development, metabolic profile has an important role too.

[gl] Obxectivos: O obxectivo principal do presente estudo é determinar a prevalencia de fibrose avanzada e definir os factores de risco asociados á mesma, medida mediante EH, en doentes con HCB clasificados como portadores inactivos, non portadores inactivos (en tratamento ou non) e coinfectados por VIH. Como obxectivos secundarios atópanse: avaliar o efecto do tratamento antiviral na fibrose hepática, valorar a progresión da fibrose hepática nas distintas fases da HCB e comparar a EH parar avaliar a fibrose hepática con test serolóxicos de APRI e FIB-4 en doentes monoinfectados por VHB e coinfectados por VIH. Método: Estudo prospectivo, observacional, aberto que inclúe 221 pacientes con HCB seguidos no Hospital Universitario da Coruña entre maio de 2010 e xuño de 2014. Realizouse EH a todos os doentes de maneira basal e durante o seguemento. Recolléronse nunha base de datos unificada todas a variables clínicas, epidemiolóxicas e de laboratorio. Realizáronse análises univariantes e de regresión loxística con obxecto de determinar os factores de risco asociados á fibrose avanzada e a probable cirrose. Realizouse un estudo de correlación e concordancia diagnóstica entre a EH e os test de APRI e FIB-4. Resultados: A prevalencia de fibrose avanzada en portadores inactivos foi de 25%, en doentes con HCB non tratada non portadores inactivos 44%, en doentes tratados 47,7% e en coinfectados polo VIH 57,4%. Nos portadores inactivos, os factores metabólicos relacionáronse coa presenza de fibrose avanzada e posible cirrose. Nos doentes non tratados con ADN VHB >2000UI/mL, a carga viral e o aumento de transaminasas foron os factores asociados. Nos doentes con tratamento antiviral, tanto mono como VIH coinfectados, os factores metabólicos, a persistencia de AgHBe e a coinfección por VHD foron os factores asociados. Tras 24 meses de seguemento, o 6,6% dos portadores inactivos e o 22,2% dos doentes non tratados presentan progresión da fibrose, mentres que o 14,3% dos doentes monoinfectados tratados e o 9,6% dos coinfectados presentan regresión. O coeficiente de correlación entre o índice de APRI e a EH foi r=0,614 e entre o FIB-4 e a EH r=0,642. Conclusións: A EH mostrouse eficaz para a caracterización e monitorización da fibrose en doentes con HCB, así como nos coinfectados polo VIH. Ademais dos factores dependentes da propia HCB, o perfil metabólico xoga un papel importante no desenvolvemento da fibrose hepática.