Evaluation of normal or minimally elevated alanine transaminase, age and DNA level in predicting liver histological changes in chronic hepatitis B

[Guest guest]

http://onlinelibrary.wiley.com/doi/10.1111/j.1478-3231.2011.02491.x/abstract

Evaluation of normal or minimally elevated alanine transaminase, age and DNA

level in predicting liver histological changes in chronic hepatitis B

Shahinul Alam, Nooruddin Ahmad, Golam Mustafa, Ananta Shrestha, AKM Khorshed

Alam, Mobin KhanArticle first published online: 6 MAR 2011

DOI: 10.1111/j.1478-3231.2011.02491.x

© 2011 Wiley & Sons A/S

Issue

Liver International

Volume 31, Issue 6, pages 824–830, July 2011

Abstract

Background: Serum alanine transaminase (ALT), hepatitis B virus (HBV) DNA level

and age are used in the evaluation of chronic hepatitis B (CHB).

Aim: We designed this study to evaluate liver histology with ALT and its

relation with age and HBV DNA.

Methods: During the period of October 2006 to July 2009, 499 CHB patients were

included in this study with detectable HBV DNA at PCR. Of these, 181 had normal

ALT, 200 had ALT [>(1 × ULN) <(2 ULN)] and 118 had ALT≥2 ULN and were

labelled as Group 1, 2 and 3 respectively.

Results: A strong positive correlation was found between ALT and histological

activity index (HAI) and fibrosis. However, 29 (52.7%) and five (9.1%) in Group

1 with positive HBeAg status had HAI ≥4 and fibrosis ≥2 respectively. Among

those with HBeAg-negative status, 66 (23.1%) had HAI >4 and 31 (10.8%) had

fibrosis ≥2. In Group 2, 14 (15.7%) had moderate-to-severe HAI and 19 (21.2%)

had fibrosis ≥2 when HBeAg was positive, in those with HBeAg negative 34

(30.6%) had moderate-to-severe HAI and 38 (34.2%) had fibrosis ≥2. An ALT

value of ≥58.5 U/l had higher sensitivity than that of 80 U/l in predicting

significant histological changes. Further, HAI and fibrosis were significantly

greater in the age of >30 years.

Conclusions: We recommend liver biopsy in HBeAg-negative CHB over 30 years of

age regardless of ALT level and starting treatment at ALT 1.5 × ULN instead of

2 × ULN.

[Guest guest]

http://onlinelibrary.wiley.com/doi/10.1111/j.1478-3231.2011.02491.x/abstract

Evaluation of normal or minimally elevated alanine transaminase, age and DNA

level in predicting liver histological changes in chronic hepatitis B

Shahinul Alam, Nooruddin Ahmad, Golam Mustafa, Ananta Shrestha, AKM Khorshed

Alam, Mobin KhanArticle first published online: 6 MAR 2011

DOI: 10.1111/j.1478-3231.2011.02491.x

© 2011 Wiley & Sons A/S

Issue

Liver International

Volume 31, Issue 6, pages 824–830, July 2011

Abstract

Background: Serum alanine transaminase (ALT), hepatitis B virus (HBV) DNA level

and age are used in the evaluation of chronic hepatitis B (CHB).

Aim: We designed this study to evaluate liver histology with ALT and its

relation with age and HBV DNA.

Methods: During the period of October 2006 to July 2009, 499 CHB patients were

included in this study with detectable HBV DNA at PCR. Of these, 181 had normal

ALT, 200 had ALT [>(1 × ULN) <(2 ULN)] and 118 had ALT≥2 ULN and were

labelled as Group 1, 2 and 3 respectively.

Results: A strong positive correlation was found between ALT and histological

activity index (HAI) and fibrosis. However, 29 (52.7%) and five (9.1%) in Group

1 with positive HBeAg status had HAI ≥4 and fibrosis ≥2 respectively. Among

those with HBeAg-negative status, 66 (23.1%) had HAI >4 and 31 (10.8%) had

fibrosis ≥2. In Group 2, 14 (15.7%) had moderate-to-severe HAI and 19 (21.2%)

had fibrosis ≥2 when HBeAg was positive, in those with HBeAg negative 34

(30.6%) had moderate-to-severe HAI and 38 (34.2%) had fibrosis ≥2. An ALT

value of ≥58.5 U/l had higher sensitivity than that of 80 U/l in predicting

significant histological changes. Further, HAI and fibrosis were significantly

greater in the age of >30 years.

Conclusions: We recommend liver biopsy in HBeAg-negative CHB over 30 years of

age regardless of ALT level and starting treatment at ALT 1.5 × ULN instead of

2 × ULN.

[Guest guest]

http://onlinelibrary.wiley.com/doi/10.1111/j.1478-3231.2011.02491.x/abstract

Evaluation of normal or minimally elevated alanine transaminase, age and DNA

level in predicting liver histological changes in chronic hepatitis B

Shahinul Alam, Nooruddin Ahmad, Golam Mustafa, Ananta Shrestha, AKM Khorshed

Alam, Mobin KhanArticle first published online: 6 MAR 2011

DOI: 10.1111/j.1478-3231.2011.02491.x

© 2011 Wiley & Sons A/S

Issue

Liver International

Volume 31, Issue 6, pages 824–830, July 2011

Abstract

Background: Serum alanine transaminase (ALT), hepatitis B virus (HBV) DNA level

and age are used in the evaluation of chronic hepatitis B (CHB).

Aim: We designed this study to evaluate liver histology with ALT and its

relation with age and HBV DNA.

Methods: During the period of October 2006 to July 2009, 499 CHB patients were

included in this study with detectable HBV DNA at PCR. Of these, 181 had normal

ALT, 200 had ALT [>(1 × ULN) <(2 ULN)] and 118 had ALT≥2 ULN and were

labelled as Group 1, 2 and 3 respectively.

Results: A strong positive correlation was found between ALT and histological

activity index (HAI) and fibrosis. However, 29 (52.7%) and five (9.1%) in Group

1 with positive HBeAg status had HAI ≥4 and fibrosis ≥2 respectively. Among

those with HBeAg-negative status, 66 (23.1%) had HAI >4 and 31 (10.8%) had

fibrosis ≥2. In Group 2, 14 (15.7%) had moderate-to-severe HAI and 19 (21.2%)

had fibrosis ≥2 when HBeAg was positive, in those with HBeAg negative 34

(30.6%) had moderate-to-severe HAI and 38 (34.2%) had fibrosis ≥2. An ALT

value of ≥58.5 U/l had higher sensitivity than that of 80 U/l in predicting

significant histological changes. Further, HAI and fibrosis were significantly

greater in the age of >30 years.

Conclusions: We recommend liver biopsy in HBeAg-negative CHB over 30 years of

age regardless of ALT level and starting treatment at ALT 1.5 × ULN instead of

2 × ULN.

[Guest guest]

http://onlinelibrary.wiley.com/doi/10.1111/j.1478-3231.2011.02491.x/abstract

Evaluation of normal or minimally elevated alanine transaminase, age and DNA

level in predicting liver histological changes in chronic hepatitis B

Shahinul Alam, Nooruddin Ahmad, Golam Mustafa, Ananta Shrestha, AKM Khorshed

Alam, Mobin KhanArticle first published online: 6 MAR 2011

DOI: 10.1111/j.1478-3231.2011.02491.x

© 2011 Wiley & Sons A/S

Issue

Liver International

Volume 31, Issue 6, pages 824–830, July 2011

Abstract

Background: Serum alanine transaminase (ALT), hepatitis B virus (HBV) DNA level

and age are used in the evaluation of chronic hepatitis B (CHB).

Aim: We designed this study to evaluate liver histology with ALT and its

relation with age and HBV DNA.

Methods: During the period of October 2006 to July 2009, 499 CHB patients were

included in this study with detectable HBV DNA at PCR. Of these, 181 had normal

ALT, 200 had ALT [>(1 × ULN) <(2 ULN)] and 118 had ALT≥2 ULN and were

labelled as Group 1, 2 and 3 respectively.

Results: A strong positive correlation was found between ALT and histological

activity index (HAI) and fibrosis. However, 29 (52.7%) and five (9.1%) in Group

1 with positive HBeAg status had HAI ≥4 and fibrosis ≥2 respectively. Among

those with HBeAg-negative status, 66 (23.1%) had HAI >4 and 31 (10.8%) had

fibrosis ≥2. In Group 2, 14 (15.7%) had moderate-to-severe HAI and 19 (21.2%)

had fibrosis ≥2 when HBeAg was positive, in those with HBeAg negative 34

(30.6%) had moderate-to-severe HAI and 38 (34.2%) had fibrosis ≥2. An ALT

value of ≥58.5 U/l had higher sensitivity than that of 80 U/l in predicting

significant histological changes. Further, HAI and fibrosis were significantly

greater in the age of >30 years.

Conclusions: We recommend liver biopsy in HBeAg-negative CHB over 30 years of

age regardless of ALT level and starting treatment at ALT 1.5 × ULN instead of

2 × ULN.