The clinical significance of persistently normal ALT in chronic hepatitis B infection

Lai, Michelle; Hyatt, Benjamin; Nasser, Imad; Curry, Michael P.; Afdhal, Nezam H.

doi:10.1016/j.jhep.2007.07.022

Cited by 307 publications

(325 citation statements)

References 13 publications

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“…Individuals older than 40 years were significantly more likely to have this condition than younger subjects upon liver biopsy. These findings are consistent with previous studies that have also shown significant histologic disease even when ALT is less than 2 9 UNL, particular in old aged patients [7,9,14]. After performing multivariate analysis with routine clinical data, we developed the Clinical model.…”

Section: Discussionsupporting

confidence: 87%

Development and Validation of a Model to Predict Advanced Fibrosis in Chronic Hepatitis B Virus-Infected Patients with High Viral Load and Normal or Minimally Raised ALT

Park

Kim

et al. 2010

Dig Dis Sci

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Background/Aims Treating a group of chronic hepatitis B virus (HBV)-infected patients with high viral load and advanced fibrosis or cirrhosis, regardless of their serum alanine aminotransferase (ALT) levels, is recommended. The aim of this study was to derive and validate a model to predict advanced fibrosis in a cohort of patients with viral replication and normal or minimally raised ALT [ALT \ 2 9 upper normal limit (UNL)]. Methods Information was collected from 124 patients who underwent liver biopsy. The diagnostic value of predictors was judged using multivariate logistic modeling and area under the receiver operating characteristic curves (ROC area). Results Advanced fibrosis (F3 or F4 on METAVIR scoring schema) was diagnosed in 45.7% (95% CI, 34-57.4%) of the patients of the derivation set (70 patients) and in 37% (95% CI, 24.2-49.9%) of the validation set (54 patients). In the derivation set, age and aspartate aminotransferase (AST) were independent clinical predictors of advanced fibrosis. The ROC areas of this Age-AST model were 0.8 (95% CI, 0.7-0.9) in the derivation set and 0.82 (95% CI, 0.71-0.93) in the validation set, respectively. Without missing a single case, this model identified 11 patients (20%) without advanced fibrosis in the validation set. Conclusions A substantial proportion of patients with high viral load and ALT \ 2 9 UNL have advanced fibrosis. A simple model including age and AST is an easily applicable tool for physicians to guide their decisions on whether or not to perform liver biopsy in individual patients.

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Section: Discussionsupporting

confidence: 87%

Development and Validation of a Model to Predict Advanced Fibrosis in Chronic Hepatitis B Virus-Infected Patients with High Viral Load and Normal or Minimally Raised ALT

Park

Kim

et al. 2010

Dig Dis Sci

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“…Many initial studies had shown that among patients with CHBV infection with normal ALT, about 50-90% of patients had either minimal changes or chronic persistent hepatitis on biopsy [17][18][19][20]. Recently, however, studies have described contrary findings also [21][22][23][24].…”

Section: Fallacies Of Alt Levels For Prediction Of Liver Injury and Tmentioning

confidence: 99%

“…In total, 18% of patients with PNALT had stage 2+ fibrosis and 34% had grade 2 or 3 inflammation. Overall 37% of patients with PNALT had significant fibrosis or inflammation [23].…”

Section: Fallacies Of Alt Levels For Prediction Of Liver Injury and Tmentioning

confidence: 99%

Should chronic HBV infected patients with normal ALT treated: debate

Sarin

Kumar

2008

Hepatol Int

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Alanine aminotransferase (ALT) levels have traditionally been used for treatment decisions in chronic hepatitis B virus (CHBV) infected patients. But recent data have raised doubts on this wisdom, as a significant proportion of CHBV infected patients with normal ALT have high HBVDNA levels and significant liver injury at presentation especially in areas of intermediate to high endemicity. A normal ALT value only identifies patients less likely to respond to current treatments, rather than patients who are not in need of the treatment. Patients with CHBV infection with normal ALT should be considered for treatment based on the HBV DNA levels and histological injury.

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“…[1][2][3][4][5][6][7] It is well documented that during the natural history of chronic HBV infection, the risk for cirrhosis increases significantly with increasing HBV DNA levels and are independent of hepatitis B e-antigen status and serum alanine aminotransferase (ALT) level. 1 Also, increased HBV DNA load (serum HBV DNA>10 5 copies/ml) is strongly associated with increased hepatocellular carcinoma and liver-related mortality after accounting for baseline cirrhosis, hepatitis B e antigen status, and ALT levels.…”

Section: Introductionmentioning

confidence: 99%

Hepatic necroinflammation and severe liver fibrosis in patients with chronic hepatitis B with undetectable HBV DNA and persistently normal alanine aminotransferase

Alam

Mahtab

Akbar

et al. 2015

Bangladesh Med Res Counc Bull

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Both consensus and controversy remains regarding surrogacy of hepatitis B virus (HBV) deoxyribonucleic acid (DNA) and alanine aminotransferase (ALT), however, these markers are used to ascertain the extent of liver damages and to guide therapeutic options in patients with chronic hepatitis B. However, little is known about liver histology of patients with chronic hepatitis B with undetectable HBV DNA and persistently normal ALT. Thirty-five incidentally-detected patients with chronic HBV infection (assessed by expression of hepatitis B surface antigen for more than 6 months) with undetectable HBV DNA and normal serum ALT were enrolled in this study. Liver biopsy specimens were taken from all patients and the extent of hepatic necroinflammation and liver fibrosis were evaluated. Moderate degree of hepatic necroinflammation was detected in 2 of 35 patients and severe hepatic fibrosis was seen in 6 of 35 patients. Two patients with undetectable HBV DNA and sustained normal ALT had moderate hepatic necroinflammation and severe hepatic fibrosis. In spite of undetectable HBV DNA for prolonged period and persistently normal ALT, some patients with chronic hepatitis B express evidences of progressive liver diseases. Large scale studies in different races and geographical regions should be accomplished to develop insights about management of these patients. Studies about extent of liver diseases in these patients should be accomplished in Treatment recommendation and management strategies should be developed for these patients.

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The clinical significance of persistently normal ALT in chronic hepatitis B infection

Cited by 307 publications

References 13 publications

Development and Validation of a Model to Predict Advanced Fibrosis in Chronic Hepatitis B Virus-Infected Patients with High Viral Load and Normal or Minimally Raised ALT

Development and Validation of a Model to Predict Advanced Fibrosis in Chronic Hepatitis B Virus-Infected Patients with High Viral Load and Normal or Minimally Raised ALT

Should chronic HBV infected patients with normal ALT treated: debate

Hepatic necroinflammation and severe liver fibrosis in patients with chronic hepatitis B with undetectable HBV DNA and persistently normal alanine aminotransferase

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