Abstract
ALT is one of the most sensitive biochemical indexes to reflect liver injury. It is generally believed that hepatitis B virus (HBV) infected patients with normal ALT levels are in either immune tolerance or low replication stage of the natural history of hepatitis B, and there is no or only mild inflammation in liver tissue, so antiviral therapy is not recommended. However, chronic HBV-infected patients with normal ALT levels are not always in a stable state. A considerable number of patients will develop active hepatitis or occult progress to liver fibrosis, cirrhosis, and hepatocellular carcinoma. Therefore, whether antiviral therapy should be recommended for chronic HBV infection with normal ALT level has been a hot topic in clinical practice. In this paper, the definition of immune tolerance, the relationship between ALT and liver inflammation, and the benefits of antiviral therapy were reviewed, and we hope it will be helpful for clinicians to have a deeper understanding of whether antiviral therapy should be considered for chronic HBV infection with normal ALT.
Highlights
Hepatitis B virus (HBV) infection is one of the most common infectious diseases in the world
It is generally believed that hepatitis B virus (HBV) infected patients with normal ALT levels are in either immune tolerance or low replication stage of the natural history of hepatitis B, and there is no or only mild inflammation in liver tissue, so antiviral therapy is not recommended
Due to immune tolerance of the host against HBV, some patients are with normal ALT, positive HBeAg, and high HBV DNA levels [4]
Summary
Hepatitis B virus (HBV) infection is one of the most common infectious diseases in the world. The persistence and active replication of HBV in liver tissue is the main cause of chronic hepatitis, cirrhosis, and hepatocellular carcinoma(HCC). Due to immune tolerance of the host against HBV, some patients are with normal ALT, positive HBeAg, and high HBV DNA levels [4]. At present, for such a group of patients, antiviral therapy is not recommended by guidelines unless the patient has evidence of liver injury [5,6,7,8]
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