4-6.9) kPa, in association with the reduction of ALT levels (Figure (Figure3B3B). Treated patients: The FS monitoring started with treatment in 18 patients, when treatment was already ongoing in the remaining 13. Overall, FS values showed progressive declines currently during therapy, with a mean on-treatment/baseline ratio of 0.9 �� 0.4 at 6 mo and 0.7 �� 0.2 at 12 mo. In patients with persistent response to long-term nucleoside/nucleotide analogues treatment, FS values decreased progressively during their follow up, with mean yearly reduction (ratio between two consecutive FS values registered at 12 mo intervals) of 0.8 �� 0.2 at 24 mo, 0.8 �� 0.1 at 36 mo and 0.7 �� 0.1 at 48 mo from the beginning of therapy. All responders showed decreased FS values during therapy (Figure (Figure3C3C and andD):D): 0.
8 �� 0.2 at 6 mo and 0.6 �� 0.2 at 12 mo, as compared to baseline values, respectively. FS value declines were similar in responders to IFN as compared to responders to NA: 0.7 �� 0.2 vs 0.8 �� 0.2 6 mo/baseline ratio and 0.6 �� 0.1 vs 0.7 �� 0.2 12 mo/baseline ratio, respectively. Two non-responder HBeAg-positive patients showed an increase of 1.1 and 2.4 times the FS values between 3 and 6 mo, during hepatitis flares, followed by a progressive decline that reached baseline values after 12 mo. DISCUSSION Transient elastography[1] is an easy to perform, reproducible method for the rapid and objective evaluation of LS in clinical practice[2,16] and it is proposed as a reliable, non-invasive, surrogate marker of fibrosis[3-7,17,18].
In fact, LS is a physical parameter that correlates primarily with fibrosis, but it is influenced also by other factors that modify the elasticity of the liver, such as significant variations of inflammatory infiltrate, edema and vascular congestion of the liver[8-10,19]. Accordingly, we showed that LS variations parallel ALT values during hepatitis exacerbations in the setting of both acute and chronic liver damage[8]. This evidence has important implications in clinical practice since the interpretation of the LS measure has to take into account the concurrent biochemical profile of the patient[8]. Thus, the interpretation of LS might be more difficult in the setting of CHB when major fluctuations of necrosis and inflammatory activity occur in a significant proportion of patients[11,12,18,19].
On the other hand, the availability of an easy to perform, non-invasive measure for fibrosis might improve the management of the HBV carrier. In the HBV carrier, the repeated measures of LS might Cilengitide help to identify the candidates for liver biopsy and to define both the phase of HBV infection and stage of liver disease that are mandatory to warrant the most appropriate treatment strategy, and to monitor liver disease progression in the single patient[20,21].
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