The level of alanine aminotransferase (ALT) is a marker of hepatitis B severity and response to treatment.
However, measurements of ALT level may be of limited use during the immune clearance phase of chronic hepatitis B and can be affected by age, weight, and concomitant liver disease.
Dr Mindie Nguyen and colleagues from California, USA performed a literature review to determine the proportion of chronic hepatitis B patients with ALT levels of 1- to 2-fold the upper limit of normal who also had significant underlying liver fibrosis.
The team performed a Medline search of original articles published before 2012, and their references.
The researchers also searched abstracts from the 2010 and 2011 annual meetings of the American Association for the Study of Liver Diseases and the 2011 and 2012 Digestive Disease Weeks.
|48% of patients had stage 2 or higher fibrosis|
|Clinical Gastroenterology & Hepatology|
Studies were included that had 20 or more consecutive treatment-naive chronic hepatitis B patients with 6 months or more of follow-up evaluation, histologic data, and levels of ALT 1- to 2-fold the upper limit of normal.
The team evaluated 8 articles and 1 abstract, comprising 683 patients.
Based on random-effects modeling, the researchers found that 48% of patients had stage 2 or higher fibrosis.
In a sensitivity analysis, exclusion of the study that caused the greatest deflection of the pooled estimate produced a revised estimate of 43%.
A subgroup of hepatitis B e antigen–positive and hepatitis B e antigen–negative patients showed similar rates of fibrosis.
Dr Nguyen's team concludes, "Despite heterogeneity in the literature, a substantial proportion of patients with slight increases in ALT level have significant fibrosis."
"Given the possibility of advanced liver disease, the threshold for antiviral treatment must be individualized."
"Further studies are needed to investigate patients with modest increases in ALT level."