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Chronic hepatitis B patients with normal alanine transaminase and hepatic fibrosis

February's issue of the Alimentary Pharmacology & Therapeutics investigates the proportion of chronic hepatitis B patients with normal alanine transaminase ≤40 IU/L and significant hepatic fibrosis.

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Chronic hepatitis B (CHB) may lead to cirrhosis, hepatocellular carcinoma and premature death. Elevated alanine transaminase (ALT) levels ≥ the upper limit of normal (ULN) are a major determinant for initiating anti-viral therapy.

However, ALT levels alone may not be predictive of hepatic fibrosis.

Dr Nguyen and colleagues from California determined the proportion of chronic hepatitis B patients with ALT ≤40 IU/L and liver fibrosis stage ≥2.

Secondary goals include subgroup analysis by hepatitis B e antigen (HBeAg) status, high hepatitis B virus (HBV) DNA levels, Asian ethnicity, lower ULN of ≤30 IU/L (males) and 19 IU/L (females), and advanced age.

Approximately one fifth of patients with ALT ≤40 IU/L may have hepatic fibrosis
Alimentary Pharmacology & Therapeutics

The team identified studies in EMBASE and MEDLINE (1/1990–6/2012) using the search criteria “Hepatitis B”[Mesh] OR “Hepatitis B virus”[Mesh] OR “Hepatitis B, Chronic”[Mesh])) AND “Alanine Transaminase”[Mesh]) and abstracts containing the term ‘hepatitis’ from recent major U.S. gastroenterology and liver society meetings.

Among 9 studies, the team found that a significant proportion of chronic hepatitis B patients with ALT levels ≤40 IU/L had significant fibrosis irrespective of HBeAg status, high HBV DNA levels, ethnicity or age, although this proportion may be higher in patients older than 30–40 years old.

The research team observed that the corresponding proportion was 28% even when the newer ULN of 30 IU/L (males) and 19 IU/L (females) was applied.

Dr Nguyen's team concludes, "Approximately one fifth of chronic hepatitis B patients with ALT ≤40 IU/L may have significant hepatic fibrosis."

"The approach to such patients should be individualized, as further evaluation and treatment may be appropriate."

Aliment Pharmacol Ther 2014: 39(4): 349–358
30 January 2014

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