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Int J Infect Dis. 2016 Nov;52:68-73. doi: 10.1016/j.ijid.2016.09.007. Epub 2016 Sep 9.

Predictors of treatment requirement in HBeAg-negative chronic hepatitis B patients with persistently normal alanine aminotransferase and high serum HBV DNA levels.

Author information

1
Department of Gastroenterohepatology, Istanbul Faculty of Medicine, Istanbul University, Capa, 34390, Istanbul, Turkey.
2
Medipol University, Department of Nephrology, Istanbul, Turkey.
3
Department of Gastroenterology, Koç University Hospital, Istanbul, Turkey.
4
Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
5
Department of Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
6
Department of Gastroenterohepatology, Istanbul Faculty of Medicine, Istanbul University, Capa, 34390, Istanbul, Turkey. Electronic address: kaymakoglus@hotmail.com.

Abstract

OBJECTIVES:

Serum alanine aminotransferase (ALT) is a controversial marker for disease monitoring in hepatitis B e antigen (HBeAg)-negative chronic hepatitis B (CHB) patients. The aim of this study was to determine the fibrosis stage and histological activity index (HAI) in HBeAg-negative CHB patients with persistently normal ALT (PNALT) and high serum HBV DNA (≥2000 IU/ml) and to investigate clinical risk factors for the requirement of treatment through the examination of liver biopsy specimens.

METHODS:

HBeAg-negative CHB patients with PNALT (≤40 IU/l) and high serum HBV DNA (≥2000 IU/ml) were included. HBV fibrosis stage and HAI were scored according to the Ishak system. Multivariate logistic regression analysis was used to estimate the independent risk factors for fibrosis stage ≥2 and/or HAI ≥6. Receiver operating characteristic curve analysis was used to determine an optimal age cut-off for liver biopsy.

RESULTS:

A total 120 patients were enrolled. These patients had a mean HBV DNA level of 123680±494500 IU/ml; the HBV DNA load was 2000-20000 IU/ml in 68 patients (56.6%) and ≥20000 IU/ml in 52 (43.4%). Eighteen patients (15%) had moderate-to-severe histological activity (HAI ≥6). Forty-three patients (35.9%) had a fibrosis stage ≥2. Forty-eight patients (40%) had a fibrosis stage ≥2 and/or HAI ≥6. On multivariate logistic regression analysis, independent variables associated with fibrosis stage ≥2 and/or HAI ≥6 included age and HBV DNA viral load. Patients with HBV DNA 2000-20000 IU/ml were more likely to require treatment compared to those with a viral load ≥20000 IU/ml. The optimal age cut-off to predict fibrosis stage ≥2 and/or HAI ≥6 was 46 years.

CONCLUSIONS:

Significant liver damage was detected in 40% of CHB patients with PNALT and high HBV DNA upon biopsy. Age and HBV DNA viral load were independent predictors of significant liver damage. A biopsy to determine the degree of liver damage is advisable for CHB patients older than 46 years.

KEYWORDS:

Chronic hepatitis B; HBeAg-negative; Persistently normal ALT

PMID:
27619844
DOI:
10.1016/j.ijid.2016.09.007
[Indexed for MEDLINE]
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