Approach and management of incidentally detected asymptomatic HBsAg-positive subject (IDAHS) with normal ALT and HBV DNA > 105 copies

Background & Objective: As compare to true inactive carrier a significantly different prognosis generally observed in Patients with HBeAg-negative chronic hepatitis B (CHB). To differentiate this two condition accurately there are no reliable strategy. To determine follow-up strategy for differentiating a true inactive carriers from chronic hepatitis patients with HBeAg negative by the HBV DNA cutoff value. Materials and Methods: We had enrolled potential inactive carriers who were consecutive untreated patients. This inactive carriers defined as HBV DNA < 2000 IU/mL, normal ALT levels, anti-HBe-positive and definitely HBeAg-negative. HBV DNA level to ≥ 2000 IU/mL was defined as the HBV reactivation. Patients whose HBV DNA levels remained at < 2000 IU/mL were classified as true inactive carriers and patients whose HBV DNA level to ≥ 2000 were classified as false inactive carriers during the first year. Results: Among 112 inactive carrier (age, 48.3 ± 13.1 years) who were initially selected, 75 were males. As identified, 23.2 ± 7.9 IU/L and 359 ± 478 IU/mL were serum ALT and HBV DNA levels, respectively. In 24 patients there were a significant drop in HBV reactivation during the first year. Between true and false inactive carriers there were a significantly different ALT and HBV DNA levels. In patients, whose baseline HBV DNA level was ≥ 200 IU/mL as compare to patients whose baseline HBV DNA level was < 200 IU/mL, HBV reactivation developed more often during a follow-up of 354 ± 175 days. Conclusion: From true inactive carriers to differentiate patients with HBeAg-negative CHB, HBV DNA level was useful tool. As per HBV DNA level of inactive carriers applied follow-up strategies need to vary.

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Parameters Associated with Significant Liver Histological Changes in Patients with Chronic Hepatitis B

ISRN Gastroenterology ◽

10.1155/2014/913890 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 6

Author(s):

Li Xiao ◽

Jianchun Xian ◽

Yang Li ◽

Aiwen Geng ◽

Xiuzhen Yang ◽

...

Keyword(s):

Chronic Hepatitis ◽

Hepatitis B ◽

Hbv Dna ◽

Advanced Fibrosis ◽

Histological Changes ◽

Factors Associated ◽

Liver Histopathology ◽

Liver Biopsies ◽

Chronic Hbv ◽

Normal Alt

This study aimed to evaluate factors associated with significant liver histological changes. Liver biopsies from 157 CHB patients were retrospectively analyzed. Only ALB was significantly correlated with advanced liver necroinflammatory (P=0.001). Age, ALB, GLOB, AST, PLT, and PT were independent predictors of significant fibrosis (P=0.002, P<0.001, P=0.001, P=0.048, P<0.001, and P=0.001, resp.). AST, WBC, and HBV DNA were significantly correlated with advanced fibrosis in normal ALT patients (P<0.001, P=0.041, and P=0.012, resp.) and age, ALB, GLOB, PLT, and PT in patients with abnormal ALT (P=0.003, P<0.001, P=0.004, P<0.001, and P=0.002, resp.). Age, AST, GGT, PLT, and PT were significantly associated with advanced fibrosis in HBeAg+ patients (P=0.01, P=0.016, P=0.027, P=0.016, and P=0.009, resp.) and ALB, GLOB, WBC, PLT, and PT in HBeAg− patients (P<0.001, P=0.004, P=0.005, P<0.001, and P=0.035, resp.). PLT was an excellent predictor for cirrhosis (P<0.001 and AUROC=0.805). ALT was not predictive of advanced fibrosis for patients with HBeAg+ or HBeAg− (P=0.273 and P=0.599, resp.). PLT was an excellent predictor for cirrhosis in CHB patients. Liver histopathology can be recommended for chronic HBV carriers of older age, with normal ALT, lower PLT, and lower ALB.

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Su1019 High Normal ALT and Borderline HBV DNA Were Predictors for Future Treatment Eligibility in Chronic Hepatitis B (CHB) Patients Who Initially Did Not Meet Criteria

Gastroenterology ◽

10.1016/s0016-5085(14)63510-1 ◽

2014 ◽

Vol 146 (5) ◽

pp. S-964

Author(s):

Lindsay Uribe ◽

Nghia Nguyen ◽

Long H. Nguyen ◽

Lily H. Kim ◽

Huy N. Trinh ◽

...

Keyword(s):

Chronic Hepatitis ◽

Hepatitis B ◽

Chronic Hepatitis B ◽

Hbv Dna ◽

Future Treatment ◽

Normal Alt

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The Relationship between Intrahepatic Distribution of Hepatitis B Virus Core Antigen and Serum ALT, HBV DNA Levels and HBeAg Status

Infection International ◽

10.1515/ii-2017-0013 ◽

2012 ◽

Vol 1 (2) ◽

pp. 84-90 ◽

Cited By ~ 1

Author(s):

Qing He ◽

Qi-yuan Tang ◽

Xiao-hua Le ◽

De-liang Lv ◽

Xiang-mei Zhang ◽

...

Keyword(s):

Hepatitis B Virus ◽

Hepatitis B ◽

Hbv Dna ◽

Inflammatory Activity ◽

Activity Score ◽

Core Antigen ◽

B Virus ◽

Normal Alt ◽

The Relationship ◽

Hbeag Status

Abstract Objective The clinical significance of differential distribution of hepatitis B virus (HBV) nucleocapsid antigen in hepatocytes remains unknown. The goal of this study is to determine the relationship between distinct HBV core antigen distribution pattern and alanine transaminase (ALT), liver histological inflammatory activity grades, serum HBeAg status and HBV DNA level.Methods Total of 958 cases with chronic hepatitis B were recruited into this study. Liver function tests, serum HBV DNA level, serological HBV markers and liver immunohistochemistry were examined according to the conventional instructions. Chi Square tests were performed to analyze the differences among these groups.Results It was found that 552 (58%) cases were tested positive for HBV core antigen by immunohistochemical staining. Cytoplasmic hepatitis B core antigen (HBcAg) expression correlated with ALT level and serum HBV DNA and liver inflammatory activity scores, however, nuclear HBcAg expression in hepatocytes was associated with normal ALT level, lower liver inflammatory activity score and higher serum HBV DNA level and rate of HBeAg positivity. Both nuclear and cytoplasmic HBcAg expression in hepatocytes associated with a middle ALT level and liver inflammatory activity score, higher rate of serum detectable HBeAg and a higher HBV DNA level. However, undetectable core antigen was related to a lower ALT level and histological inflammatory activity grade, lower positive HBeAg rate and HBV DNA level.Conclusions Undetectable liver HBcAg is associated with HBV clearance, ALT normalization and hepatitis B e antigen (HBeAg) seroconversion, and cytoplasmic HBcAg expression associated with higher hepatic inflammatory activity. However, nuclear HBcAg expression correlates with immune tolerance characterized with normal ALT and lower liver inflammatory activity, higher HBV replication level and higher rate of HBeAg positivity.

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HBV-DNA, HBeAg/anti-HBe serological status in hepatitis B chronic individuals from central Italy

Epidemiology and Infection ◽

10.1017/s0950268800047518 ◽

1990 ◽

Vol 104 (3) ◽

pp. 511-518 ◽

Cited By ~ 6

Author(s):

M. Rapicetta ◽

V. Di Nardo ◽

C. Rozera ◽

G. Marinucci ◽

D. Francisci ◽

...

Keyword(s):

Liver Disease ◽

Hepatitis B ◽

Central Italy ◽

Hbv Dna ◽

Hbsag Carrier ◽

Chronic Patients ◽

Asymptomatic Carriers ◽

Serological Status ◽

Histological Activity ◽

Normal Alt

SUMMARYA population of 488 HBsAg carrier individuals, from central Italy, classified on the basis of biochemical, clinical and histological parameters, was analysed for the presence of HBV-DNA in serum and its relationship with HBeAg/anti-HBe markers. The prevalence of HBV-DNA was 32·8% in chronic patients with biopsy-proven liver disease, and 20 and 4·3% respectively in asymptomatic carriers with and without altered ALT levels. The values in chronic patients were correlated with the histological activity.Concordance of HBV-DNA presence and HBeAg positivity was observed in only 61·4% of cases. However HBV-DNA prevalence in sera of anti-HBe positive individuals was very low in asymptomatic carriers with normal ALT levels (2·5%). Higher values were observed in anti-HBe positive chronic patients (15·8%) and in carriers occasionally found with changes in ALT without any other clinical sign of illness (16·7%). These data would indicate that HBV-DNA is the serological marker which is most closely related to liver disease.

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Hepatic necroinflammation and severe liver fibrosis in patients with chronic hepatitis B with undetectable HBV DNA and persistently normal alanine aminotransferase

Bangladesh Medical Research Council Bulletin ◽

10.3329/bmrcb.v40i3.25229 ◽

2015 ◽

Vol 40 (3) ◽

pp. 92-96 ◽

Cited By ~ 6

Author(s):

MM Alam ◽

MA Mahtab ◽

SMF Akbar ◽

M Kamal ◽

S Rahman

Keyword(s):

Chronic Hepatitis ◽

Liver Fibrosis ◽

Hepatitis B ◽

Chronic Hepatitis B ◽

Hepatic Fibrosis ◽

Alanine Aminotransferase ◽

Liver Diseases ◽

Hbv Dna ◽

Treatment Recommendation ◽

Normal Alt

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.Bangladesh Med Res Counc Bull 2014; 40 (3): 92-96

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Prevalence of HBV-genotypes in immigrants affected by HBV-related chronic active hepatitis

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032007000100012 ◽

2007 ◽

Vol 44 (1) ◽

pp. 54-57 ◽

Cited By ~ 15

Author(s):

Emilio Palumbo ◽

Gaetano Scotto ◽

Giuseppina Faleo ◽

Donatella Concetta Cibelli ◽

Annalisa Saracino ◽

...

Keyword(s):

Antiviral Treatment ◽

Hbv Dna ◽

Hbv Infection ◽

Genotype Distribution ◽

Hbv Genotype ◽

Hbv Genotypes ◽

Sub Saharan ◽

Normal Alt ◽

Different Response ◽

Detectable Serum

BACKGROUND: The genetic heterogeneity of the HBV genome has been established and eight genotypes can be classified according to the criterion of >8% differences in the complete nucleotide sequence of the viral genome. AIMS: To evaluate the prevalence of HBV-infection in a population of immigrants and to determine in patients with detectable serum HBV-DNA the HBV-genotypes. METHODS: Between January 2005 and December 2005 a total of 556 immigrants were tested for HBsAg. In HBsAg positive patients the biochemical and virological activity of infection and the possible presence of co-infections (HCV, HDV, HIV) were evaluated. In patients with detectable serum HBV DNA, the HBV-genotype was determined by INNOLiPA. RESULTS: Among the 556 subjects tested, 60 (10.7%) resulted HBsAg positive. All were men, and 42 (70%) come from Africa, 10 (16.6%) from Asia and 9 (14.4%) from East-Europe. 28/60 (46.6%) patients presented normal ALT levels (<40 IU/L) and undetectable serum HBV DNA (<100 copies/mL in real-time PCR), while 32 (53.4%) patients had ALT levels above laboratory normal values and detectable serum HBV DNA. Genotype distribution was as follow: genotype E, 16 (50%), genotype D, 9 (28.1%), genotype A, 7 (21.9%). CONCLUSION: Our study evidences a moderate prevalence of HBV-infection in immigrants, particularly in sub-Saharan African people, and the potentiality of migratory flow in the introduction of genotype non-D hepatitis B virus, potentially characterized by a different natural history and, possibly, a different response to antiviral treatment.

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Hepatitis B virus DNA in the serum of Sardinian blood donors negative for the hepatitis B surface antigen

Blood ◽

10.1182/blood.v73.1.17.bloodjournal73117 ◽

1989 ◽

Vol 73 (1) ◽

pp. 17-19

Author(s):

ME Lai ◽

P Farci ◽

A Figus ◽

A Balestrieri ◽

M Arnone ◽

...

Keyword(s):

Hepatitis B Virus ◽

Hepatitis B ◽

Surface Antigen ◽

Dna Sequences ◽

Blood Donors ◽

Hepatitis B Surface Antigen ◽

Hbv Dna ◽

Hbv Infection ◽

B Virus ◽

Normal Alt

The high endemicity of hepatitis B virus (HBV) infection and liver disease in Sardinia led us to assess the occurrence of HBV DNA in 1,411 sera of two selected groups of hepatitis B surface antigen (HBsAg)- negative blood donors: 793 with abnormal serum alanine aminotransferase (ALT) and 618 with normal serum ALT values (determined during routine testing of their blood donation). HBV DNA sequences were detected by dot-blot hybridization in 68 of 793 subjects (9%) with abnormal ALT but only in three of 618 subjects (0.5%) with normal ALT. HBV-core antibody (anti-HBc) was detected in 338 of 793 subjects (43%) with abnormal ALT as well as in 125 of 618 subjects (20.2%) with normal ALT. Among the 71 subjects positive for serum HBV DNA, 22 (31%) were positive for anti- HBc, while 49 (69%) were negative for all serologic markers of HBV infection. Thus, a high frequency of anti-HBc in apparently healthy HBsAg-negative individuals and a high prevalence of serum HBV DNA in the absence of immunologic markers of HBV infection suggest the existence of genetic variants of HBV that may be responsible for some of the presumed NANB hepatitis encountered in Sardinia and possibly other areas of high endemicity for HBV.

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Liver Histological Abnormalities Were Better Reflected by Virus Level in Chronic Hbv Infected Patients Aged ≤ 30 Years, Hbeag-Positive and Persistently Normal Alt

10.21203/rs.3.rs-1124279/v1 ◽

2021 ◽

Author(s):

Li Wei ◽

Xiaoqing Liu ◽

Qiao Tang ◽

Hu Li ◽

Peng Hu

Keyword(s):

Threshold Value ◽

Hbv Dna ◽

Roc Curve Analysis ◽

Pathological Alteration ◽

Virus Level ◽

Histological Abnormality ◽

Histological Characteristics ◽

Chronic Hbv ◽

Normal Alt ◽

Almost All

Abstract Background: We analyzed correlations between significant liver histological characteristics and clinical variables in HBV-infected patients and provided recommendations on treatment decisions for patients age younger than 30-year-old.Methods: Liver biopsy was performed on 161 chronic HBV-infected patients with ALT ≤ 40 U/L from July, 2000 – November, 2019. Median age was 39(18-70) years old. Histologic assessment was based on the Scheuer scoring system. Results: Significant necroinflammation and fibrosis were observed in 65.2% (105/161) and 52.2% (84/161) patients of all cases. The pathological abnormality was significantly negatively correlated with viral level in HBeAg-positive subjects, and based on ROC curve analysis, the viral level to predict obvious liver pathological changes was 6.7 log10 IU/ml in those patients. Threshold value of ALT (25 U/L) based on the distribution of ALT and virus levels. Patients younger than 30 years old, almost all had significant pathological alteration with HBV-DNA < 6.7 log10 IU/ml; However, the ratio of insignificant liver’s inflammation and fibrosis were 65% and 70% with HBV-DNA levels ≥ 6.7 log10 IU/ml respectively, on that basis, it could have a further rising, reaching 67.5% and 75% combining with ALT ≤ 25 U/L. Conclusion: Viral load was a better factor to reflect hepatic histological abnormality in Chronic HBV-infected patients with HBeAg-positive and persistently normal ALT whose age ≤ 30 years, 5000000 IU/ml was a suitable threshold.

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