Management of individuals with chronic hepatitis B virus infection and persistent normal or mildly elevated aminotransferase levels

Abstract

No consensus exists with respect to positive hepatitis B virus (HBV) DNA results and persistent normal or mildly elevated alanine aminotransferase (ALT). The aim of this study is to investigate the appropriate management and prognosis of these populations with chronic hepatitis B (CHB). A total of 235 subjects with positive HBV DNA results and persistent normal or mildly elevated ALT were enrolled in this study. Liver biopsy and liver stiffness measurements (LSM) were performed in all participants at baseline. Antiviral therapy was initiated in patients with significant hepatic inflammation (G ≥ 2) and/or fibrosis (S ≥ 2). The patients were divided into entecavir and adefovir groups based on HBV DNA load (>2000 IU/mL vs <2000 IU/mL). The liver biopsies were repeated at 72 weeks for the patients received antiviral therapy. We found that 112 subjects were hepatitis B e antigen (HBeAg) positive, and 123 subjects were negative. The corresponding median ALTs were 46 (39.5‐52.5) and 48 (41.5‐57.0) U/mL, respectively. G ≥ 2 and/or S ≥ 2 diseases were present in 48.8% (82/168) of the HBeAg‐positive and 51.2% (86/168) of HBeAg‐negative patients, respectively. In addition, 96 HBeAg‐positive and 72 HBeAg‐negative patients were divided into entecavir and adefovir groups. Meanwhile, liver biopsies had greater diagnostic accuracy for determining cirrhosis than LSM (0.711 vs 1.0, P < 0.0001). At the end of the study period, undetectable HBV DNA levels and normal ALT levels were observed in CHB‐infected patients. Furthermore, the patients showed histologic improvement at 72 weeks compared with baseline measurements (G, 1.72 ± 1.00 vs 0.73 ± 0.88, P = 0.0002; S, 1.484 ± 0.90 vs 0.99 ± 1.13, P < 0.0001). Collectively, liver biopsy enhanced diagnostic accuracy for CHB‐infected individuals with persistent normal or mildly elevated aminotransferase levels. Moreover, antiviral therapy can improve or regress the hepatic fibrosis and cirrhosis.

Effectiveness of Tenofovir Alafenamide in Chronic Hepatitis B Patients with Normal Alanine Aminotransferase and Positive Hepatitis B Virus DNA

“… 14 In another study, liver biopsy was performed on 235 CHB patients with normal or slightly elevated ALT, in which antiviral treatment was initiated on HBeAg-negative patients. The virological response rate was 90.7% 23 in 72 weeks. After the second liver biopsy, it was found that antiviral treatment could effectively improve the stage of liver fibrosis in CHB patients and reduce cirrhosis occurrence.…”

Effectiveness of antiviral treatment in HBeAg-negative chronic hepatitis B patients with normal or mildly elevated alanine aminotransferase: a retrospective study

“…A favourable finding in our study was the histological amelioration compared with baseline measurements observed for patients after antiviral therapy. Du et al [ 45 ] and Yan et al [ 46 ] reported that fibrosis scores decreased significantly after long-term therapy for HBeAg-negative CHB patients with either normal or elevated ALT. During our study, paired FibroScan measurements exhibited obvious changes in liver stiffness at 48 weeks and 96 weeks.…”

HBeAg-negative Patients with Chronic Hepatitis B Virus Infection and Normal Alanine Aminotransferase: Wait or Treat?

“…Studies have shown that HBeAg-negative subjects treated with NAs are more likely to obtain a reduction in HBsAg after switching to interferon. 28 A prospective cohort study by Chen et al 29 included 144 HBeAg-negative patients with chronic HBV infection including a treatment group of 102 cases and a control group of 42 cases. Treatment was with PEG-IFN-α alone or in combination with ADV, depending on the HBV DNA load.…”

“…Yan et al reported that a second biopsy after NA treatment of HBeAg-negative patients with chronic HBV infection and normal or mildly elevated ALTs for 72 weeks showed that antiviral therapy effectively improved liver histology. 28 A study by Xie et al 30 reported that liver stiffness indexes measured by the Fibro-Scan test were distinctly improved by 48 weeks of antiviral treatment in 136 HBeAg-negative patients with chronic HBV infection and normal ALTs. A study conducted by Deng et al 14 included 23 HBeAg-negative patients with chronic HBV infection and obvious inflammation and/or fibrosis in firststage liver pathology who received a second liver biopsy at an interval of 4.5 years.…”

“…reported that a second biopsy after NA treatment of HBeAg-negative patients with chronic HBV infection and normal or mildly elevated ALTs for 72 weeks showed that antiviral therapy effectively improved liver histology. 28 A study by Xie et al . 30 reported that liver stiffness indexes measured by the FibroScan test were distinctly improved by 48 weeks of antiviral treatment in 136 HBeAg-negative patients with chronic HBV infection and normal ALTs.…”