Abstract
Both consensus and controversy remains regarding surrogacy of hepatitis B virus (HBV) deoxyribonucleic acid (DNA) and alanine aminotransferase (ALT), however, these markers are used to ascertain the extent of liver damages and to guide therapeutic options in patients with chronic hepatitis B. However, little is known about liver histology of patients with chronic hepatitis B with undetectable HBV DNA and persistently normal ALT. Thirty-five incidentally-detected patients with chronic HBV infection (assessed by expression of hepatitis B surface antigen for more than 6 months) with undetectable HBV DNA and normal serum ALT were enrolled in this study. Liver biopsy specimens were taken from all patients and the extent of hepatic necroinflammation and liver fibrosis were evaluated. Moderate degree of hepatic necroinflammation was detected in 2 of 35 patients and severe hepatic fibrosis was seen in 6 of 35 patients. Two patients with undetectable HBV DNA and sustained normal ALT had moderate hepatic necroinflammation and severe hepatic fibrosis. In spite of undetectable HBV DNA for prolonged period and persistently normal ALT, some patients with chronic hepatitis B express evidences of progressive liver diseases. Large scale studies in different races and geographical regions should be accomplished to develop insights about management of these patients. Studies about extent of liver diseases in these patients should be accomplished in Treatment recommendation and management strategies should be developed for these patients.
Highlights
There are both consensus and controversy regarding real implication of serum levels of hepatitis B virus (HBV) deoxyribonucleic acid (DNA) for diagnosis and treatment of liver damages in patients with chronic hepatitis B.1-7 It is well documented that during the natural history of chronic HBV infection, the risk for cirrhosis increases significantly with increasing HBV DNA levels and are independent of hepatitis B e-antigen status and serum alanine aminotransferase (ALT) level.[1]
All patients were expressing hepatitis B surface antigen (HBsAg) for more than 6 months, but were negative for HBV DNA in the sera (HBV DNA
Utility of levels of HBV DNA and ALT, serostatus of HBeAg in clinical diagnosis and management of these patients have been supported by several studies and by global recommendations.[8,9,10]
Summary
There are both consensus and controversy regarding real implication of serum levels of hepatitis B virus (HBV) DNA for diagnosis and treatment of liver damages in patients with chronic hepatitis B.1-7 It is well documented that during the natural history of chronic HBV infection, the risk for cirrhosis increases significantly with increasing HBV DNA levels and are independent of hepatitis B e-antigen status and serum alanine aminotransferase (ALT) level.[1]. Some of them patients had liver cirrhosis when liver biopsy specimens of these patients were evaluated.[4,5,6,7] there are paucity of information about the extent of liver damages in patients with undetectable HBV DNA and persistently normal ALT. These studies have not been accomplished as these patients are regarded as inactive HBV carrier. 3 eminent professional liver organizations of the world such as The American Association for the Study of Liver Diseases (AASLD), the European Association for the Study of the Liver (EASL), and the Asian-Pacific Association for the Study of the Liver (APASL) do not recommend a liver biopsy for these patients.[8,9,10]
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