Viral and host factors related with histopathologyc activity in patients with chronic hepatitis B and moderate or intermittently elevated alanine aminotransferase levels

Abstract

Objective: viral and host factors are related with progression of pathological lesion in chronic hepatitis B. We analyzed these factors in patients with moderate or intermittently elevated ALT levels, and its threshold that determinate significant histological activity. Patients and methods: retrospective analyses of viral and host parameters in 89 consecutive chronic hepatitis B patients biopsied because of moderate or intermittently elevated ALT levels [1-2 x ULN (ULN = 39 IU/mL)] and/or DNA-HBV > 2 x 10 3 IU/mL in AntiHBe+ patients. It was analyzed age, gender, ALT levels, HBeAg, viral load and genotype. It was considered advanced histological lesion a Knodell Score (KS) > 7 and histological lesion indicating treatment, lobular inflammation ≥ 2 or fibrosis ≥ 2 according to Scheuer Classification. Results: KS > 7 and histological lesion indicating treatment was found in 47.8 and 60.7% respectively. It was observed relationship between age, male gender, ALT levels and viral load with histological damage (p < 0.05). Frequency of advanced lesion indicating treatment was upper in patients with ALT levels > ULN (69.1 vs. 47.1%, p = 0.04). There were not significant upper frequencies of advanced lesion when a cutoff of 40 years or DNA-HBV > 2 x 10 3 IU/mL viral load or serological status HBeAg was considerate. Histological activity was lesser in genotype D patients than those infected with others genotypes (p < 0.05). Conclusion: upper frequency of advanced histological lesion in chronic hepatitis B patients with moderate or intermittently elevated ALT levels make recommended liver biopsy, independent of viral load and serological status HBeAg. Other factors like age, gender or genotype can help to indicate biopsy in individual cases.

Diagnostic incidence of the presence of positive HBsAg: epidemiologic, clinical, and virological characteristics

“…In our study, liver biopsy was sometimes necessary before deciding on treatment in patients with increased HBV DNA for more than 1 year and no increased transaminase levels; in a considerable number the information provided helped us tailor therapy. Nevertheless, some authors recommend carrying out a liver biopsy to evaluate tissue damage when transaminases are elevated, irrespective of viral load (34).…”

Systematic review with meta‐analysis: the proportion of chronic hepatitis B patients with normal alanine transaminase ≤40 IU/L and significant hepatic fibrosis

“…Five were prospective, three were retrospective and one was cross-sectional in study design. Study origins included two from North America (USA), 41,42 one from East Asia (Korea), 43 one from Southeast Asia (Thailand), 44 two from South Asia (India, Bangladesh), 45,46 two from Europe (France, Spain) 47,48 and one from the Middle East (Iran). 49 The majority of studies occurred in a university or tertiary referral setting.…”

“…49 The majority of studies occurred in a university or tertiary referral setting. Six studies [41][42][43][45][46][47] involved both HBeAg-positive and HBeAg-negative patients, whereas the remaining three studies 44,48,49 evaluated only HBeAg-negative patients. All studies had a majority of male patients with the mean age ranging from 26.8 to 47.5 years old.…”

“…The majority of patients were Asian in all studies except for three. [47][48][49] Among the nine studies evaluating CHB patients with ALT ≤40 IU/L included in the primary analysis, significant fibrosis (stage ≥2) was detected in 20.7% of patients (95% CI: 16.2-26.0%) (Figure 2). There was evidence of significant statistical heterogeneity in the proportion of patients with significant fibrosis and ALT ≤40 across studies (Q-statistic = 21.9, P = 0.005; I 2 = 63.5%).…”