Virologic and histologic features of chronic hepatitis B virus-infected asymptomatic patients with p

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Gastroenterology. 2008 May;134(5):1376-84. Epub 2008 Feb 29.

Virologic and histologic features of chronic hepatitis B virus-infected

asymptomatic patients with persistently normal ALT.

Kumar M, Sarin SK, Hissar S, Pande C, Sakhuja P, Sharma BC, Chauhan R, Bose S.

Department of Gastroenterology, G. B. Pant Hospital, New Delhi, India.

BACKGROUND & AIMS: There is a paucity of data on hepatitis B virus (HBV) DNA

levels and histologic lesions in patients with chronic HBV (CHBV) infection and

persistently normal alanine aminotransferase (ALT) levels (PNALT). We studied

the ALT, HBV DNA levels, and spectrum of histologic lesions in such patients.

METHODS: One thousand three hundred eighty-seven incidentally detected

asymptomatic hepatitis B surface antigen (HBsAg)-positive patients with>/=1-year

follow-up and either PNALT (n = 189; hepatitis B e antigen [HBeAg(+)], 73;

HBeAg(-), 116) or persistently or intermittently elevated ALT (PIEALT; n = 1198;

HBeAg(+), 530; HBeAg(-), 668) were included. RESULTS: In the PIEALT and PNALT

patients, baseline DNA>/=5-log copies/mL was seen in 73.8% and 60.3% in HBeAg(+)

(P = .018) and 76% and 35.3% in HBeAg(-) (P < .001) patients and histologic

fibrosis stage>/=2 in 65.5% and 40.2% in HBeAg(+) (P < .001) and 63.9% and 13.8%

in HBeAg(-) (P < .001) patients, respectively. Approximately 21% of HBeAg(-)

patients with PNALT and HBV DNA /=3 and/or fibrosis stage>/=2). CONCLUSIONS: A

fair proportion of patients with CHBV infection with PNALT have HBV DNA>/=5-log

copies/mL and significant histologic fibrosis. Use of ALT and HBV DNA levels

without resorting to liver biopsy to define " inactive carrier state " in HBeAg(-)

PNALT patients may miss histologically significant disease in a proportion of

patients.

PMID: 18471514 [PubMed - in process]

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