@article{3140310,
    title = "Is There a Meaningful Serum Hepatitis B Virus DNA Cutoff Level for
Therapeutic Decisions in Hepatitis B e Antigen-Negative Chronic
Hepatitis B Virus Infection?",
    author = "Papatheodoridis, George V. and Manesis, Emanuel K. and Manolakopoulos, and Spilios and Elefsiniotis, Ioannis S. and Goulis, John and Giannousis, and John and Bilalis, Antonios and Kafiri, Georgia and Tzourmakliotis, and Dimitrios and Archimandritis, Athanasios J.",
    journal = "Gastroenterologie a Hepatologie",
    year = "2008",
    volume = "48",
    number = "5",
    pages = "1451-1459",
    publisher = "Wiley",
    doi = "10.1002/hep.22518",
    abstract = "The diagnosis of hepatitis B e antigen (HBeAg)-negative chronic
hepatitis B indicating therapeutic intervention currently requires serum
hepatitis B virus (HBV) DNA >= 2,000 IU/mL. We evaluated the severity of
liver histology and the presence of histological indication for
treatment in patients with HBeAg-negative chronic HBV infection focusing
on those with low viremia and/or normal alanine aminotransferase (ALT).
In total, 399 patients with increased ALT and detectable serum HBV DNA
(chronic hepatitis B patients) and 35 cases with persistently normal ALT
and HBV DNA >2,000 IU/mL (inactive carriers) were included. Histological
indication for treatment (grading score >= 7 and/or stage >= 2 in
Ishak’s classification) was found in 91% (185/203), 82% (75/91), 75%
(47/63), and 62% (26/42) of chronic hepatitis B patients with HBV DNA
>= 200,000, 20,000-199,999, 2,000-19,999, and <2,000 IU/mL, respectively
(P < 0.001). Histological indication for treatment was more frequent in
chronic hepatitis B patients with persistently elevated ALT (86% or
275/321), but it was also found in 74% (58/78) of those with
transiently normal ALT (P = 0.025). All inactive carriers had HBV DNA
<20,000 IU/mL. Histological indication for treatment was present in 17%
(6/35) of inactive carriers always due to moderate (stage 2) fibrosis
without active necroinflammation. Conclusion: HBeAg-negative chronic HBV
patients with persistently or transiently increased ALT and HBV DNA >=
20,000 IU/mL almost always require therapeutic intervention, but
histological indications for treatment are also present in the majority
of such cases with HBV DNA < 20,000 and even < 2,000 IU/mL. In contrast,
minimal histological lesions are observed in the majority of
HBeAg-negative patients with persistently normal ALT and HBV DNA > 2,000
IU/mL, who may not require immediate liver biopsy and treatment but only
close follow-up. (HEPATOLOGY 2008;48:1451-1459.)"
}