Liver damage common in chronic HBV ‘gray zone’ patients
medwireNews: A “sizable” proportion of patients with hepatitis B e antigen (HBeAg)-negative chronic hepatitis B virus (HBV) infection and persistently normal alanine aminotransferase have significant liver damage when biopsied, Turkish data show.
Despite having an ALT level at or below 40 IU/mL during the year-long study, 48 (40.0%) of the 120 patients (mean age 43 years, 48.3% men), who also had high levels of serum HBV DNA (≥2000 IU/mL), had a fibrosis stage 2 or above and/or a histologic activity index (HAI) of 6 or more according to the Ishak scoring system.
More specifically, there were 18 (15.0%) patients with an HAI of 6 or more and 43 (35.9%) with stage 2 or greater fibrosis.
These findings indicate “significant necroinflammatory activity” and a need for treatment in these patients, say Sabahattin Kaymakoglu (Istanbul University) and co-authors of the study.
The researchers also found that an HBV DNA viral load of 2000–20,000 IU/mL compared with over 20,000 IU/mL increased the odds of needing treatment (ie, having fibrosis stage ≥2 and/or HAI ≥6) 3.10-fold (p=0.017), while older age increased it 1.06-fold (p=0.017) on multivariate analysis.
Furthermore, area under the receiver operating characteristic curve analysis showed that the optimal age cutoff to predict treatment indication was 46 years, with 50.0% of patients older than 46 years and 33.3% of younger patients having fibrosis stage 2 or above and/or an HAI of 6 or more.
Therefore “[a] biopsy to determine the degree of liver damage is advisable for [chronic HBV] patients older than 46 years,” Kaymakoglu et al remark.
The team reports in the International Journal of Infectious Diseases that 68 (56.6%) patients had an HBV DNA load of 2000–20,000 IU/mL and 52 (43.4%) had a level of 20,000 IU/mL or higher, with the mean at 123,680 IU/mL.
The authors note that “treatment necessity in the HBeAg-negative [chronic HBV] infection patients with HBV DNA levels between 2000 and 20 000 IU/ml was significantly greater than found in previous studies in the literature.”
They therefore recommend “longer and more detailed follow-up” of these patients that fall within the so-called “gray zone” phase of chronic HBV infection, particularly because the year-long follow-up period is relatively short and “might [be] a limitation of [the] study with regard to the definition of persistently normal ALT.”
By Laura Cowen
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