Significant hepatic histopathology in chronic hepatitis B patients with serum ALT less than 2 x ULN and high HBV-DNA levels in Indonesia

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http://onlinelibrary.wiley.com/doi/10.1111/j.1751-2980.2011.00540.x/abstract

Accepted Date: 09/13/2011

Significant hepatic histopathology in chronic hepatitis B patients with serum

ALT less than 2 × ULN and high HBV-DNA levels in Indonesia

C. Rinaldi A. Lesmana1,2, Rino A. Gani1, Irsan Hasan1, Marcellus Simadibrata1,

Andri S. Sulaiman1, Levina S. Pakasi2, Unggul Budihusodo1, Ening Krisnuhoni3,

tius A. Lesmana1,2,*DOI: 10.1111/j.1751-2980.2011.00540.x

© 2011 The Authors. Journal of Digestive Diseases © 2011 Chinese Medical

Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital

Affiliated to Shanghai Jiaotong University School of Medicine and Blackwell

Publishing Asia Pty Ltd.

Issue

Journal of Digestive Diseases

Accepted Article (Accepted, unedited articles published online for future

issues)

Abstract

Objective: To learn the prevalence of significant hepatic histopathology in

chronic hepatitis B (CHB) patients with alanine aminotransferase (ALT) ≤ 2 ×

ULN and its association with age, HBeAg status, hepatitis B virus (HBV)-DNA

level and viral genotype.

Methods: During the 3-year period, a prospective study was conducted in

treatment-naïve CHB patients with ALT ≤ 2 × ULN. Patients with history of

acute flare hepatitis, alcohol, hepatotoxic drugs, hepatitis C, hepatitis D, and

human immunodeficiency virus co-infection were excluded from the study. Hepatic

histopathology was assessed according to the METAVIR scoring system.

Results: A total of 145 patients were recruited, 81 (55.9%) of them were male.

Patients’ mean age was 41.5 ± 10.74 years (range 16-70 years). Significant

hepatic inflammation was found in 59.3% patients, and significant hepatic

fibrosis was found in 62.1%, the latter was associated with HBeAg status, ALT

levels and serum HBV-DNA, but not with age-group, and viral genotype.

Significant hepatic fibrosis was found in 24 of 35 (68.6%) CHB patients who were

previously considered in an immunotolerance phase.

Conclusions: The prevalence of significant hepatic histopathology in CHB

patients with serum ALT levels ≤ 2 × ULN is high. Delayed antiviral treatment

can be deteriorative.