Effects of Interferon Alpha on Parathyroid Gland in Chronic Hepatitis B and C: An Observational Study

Abstract

Introduction: Serum alanine aminotransferase (ALT) remains one of three principal parameters used by AASLD, EASL, and APASL guidelines to identify candidates for antiviral therapy. Whereas individuals who are immunotolerant or inactive carriers can be safely monitored, and individuals with immune active disease clearly warrant antiviral therapy, individuals with elevated HBV DNA but normal ALT represent a subgroup for whom treatment remains controversial. Aim: We conducted a systematic review and meta-analysis to evaluate the prevalence of significant histology (grade 2 activity or stage 2 fibrosis) in individuals with chronic HBeAg positive or negative infection, elevated HBV DNA, and persistently normal serum ALT, defined as at minimum two consecutive normal values based on laboratory reference range or standarized Prati criteria six months apart. Methods: Searches of literature databases and meeting abstracts 2000-2010 were performed by two independent reviewers through September 2010. Observational studies with at least 30 patients who underwent a liver biopsy within six months of index serum ALT were included. After adjudication of a third expert reviewer, nine studies meeting quality criteria were identified, including 849 patients. Results: Pooled analyses revealed that the prevalence of significant histologic disease was 22.5% overall, 12.2% in HBeAg+ patients, and 23.7% in HBeAgpatients. Additional predictors of significant histology included HBV DNA, definitions of normal serum ALT, and number of normal serum ALT values. Conclusions: A significant proportion of patients with persistently normal serumALT and high HBVDNAhave histologic evidence of significant disease, and may represent potential candidates for antiviral therapy. Additional studies to clarify individuals to be targeted for liver biopsy and antiviral therapy in this setting are warranted.