TY - JOUR
TI - 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?
AU - Papatheodoridis, George V.
AU - Manesis, Emanuel K.
AU - Manolakopoulos,
AU - Spilios
AU - Elefsiniotis, Ioannis S.
AU - Goulis, John
AU - Giannousis,
AU - John
AU - Bilalis, Antonios
AU - Kafiri, Georgia
AU - Tzourmakliotis,
AU - Dimitrios
AU - Archimandritis, Athanasios J.
JO - Gastroenterologie a Hepatologie
PY - 2008
VL - 48
TODO - 5
SP - 1451-1459
PB - Wiley
SN - null
TODO - 10.1002/hep.22518
TODO - null
TODO - 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.)
ER -