Evaluation of normal or minimally elevated alanine transaminase, age and DNA level in predicting liver histological changes in chronic hepatitis B

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Evaluation of normal or minimally elevated alanine transaminase, age and DNA

level in predicting liver histological changes in chronic hepatitis B

Liver International, 06/17/2011

Alam S et al. – This study recommends liver biopsy in HBeAg–negative chronic

hepatitis B(CHB) over 30 years of age regardless of Serum alanine

transaminase(ALT) level and starting treatment at ALT 1.5 × ULN instead of 2 x

ULN.

Methods • During the period of October 2006 to July 2009, 499 CHB patients

were included in this study with detectable hepatitis B virus(HBV) DNA at PCR.

• Of these, 181 had normal ALT, 200 had ALT [>(1 x ULN) <(2ULN)] and 118 had

ALT≥2ULN and were labelled as Group 1, 2 and 3 respectively.

Results • Strong positive correlation was found between ALT and histological

activity index (HAI) and fibrosis.

• However, 29 (52.7%) and five (9.1%) in Group 1 with positive HBeAg status

had HAI ≥4 and fibrosis ≥2 respectively.

• Among those with HBeAg-negative status, 66 (23.1%) had HAI >4 and 31 (10.8%)

had fibrosis ≥2.

• In Group 2, 14 (15.7%) had moderate-to-severe HAI and 19 (21.2%) had

fibrosis ≥2 when HBeAg was positive, in those with HBeAg negative 34 (30.6%)

had moderate-to-severe HAI and 38 (34.2%) had fibrosis ≥2.

• ALT value of ≥58.5U/l had higher sensitivity than that of 80U/l in

predicting significant histological changes.

• Further, HAI and fibrosis were significantly greater in the age of ≥30

years.

http://www.ingentaconnect.com/content/mksg/liv/2011/00000031/00000006/art00011

Evaluation of normal or minimally elevated alanine transaminase, age and DNA

level in predicting liver histological changes in chronic hepatitis B

Authors: Alam, Shahinul; Ahmad, Nooruddin; Mustafa, Golam; Shrestha, Ananta;

Alam, AKM Khorshed; Khan, Mobin

Source: Liver International, Volume 31, Number 6, July 2011 , pp. 824-830(7)

Publisher: Wiley-Blackwell

Abstract:

Background:

Serum alanine transaminase (ALT), hepatitis B virus (HBV) DNA level and age are

used in the evaluation of chronic hepatitis B (CHB). Aim:

We designed this study to evaluate liver histology with ALT and its relation

with age and HBV DNA.

Methods:

During the period of October 2006 to July 2009, 499 CHB patients were included

in this study with detectable HBV DNA at PCR. Of these, 181 had normal ALT, 200

had ALT [>(1 × ULN) <(2 ULN)] and 118 had ALT≥2 ULN and were labelled as

Group 1, 2 and 3 respectively.

Results:

A strong positive correlation was found between ALT and histological activity

index (HAI) and fibrosis. However, 29 (52.7%) and five (9.1%) in Group 1 with

positive HBeAg status had HAI ≥4 and fibrosis ≥2 respectively. Among those

with HBeAg-negative status, 66 (23.1%) had HAI >4 and 31 (10.8%) had fibrosis

≥2. In Group 2, 14 (15.7%) had moderate-to-severe HAI and 19 (21.2%) had

fibrosis ≥2 when HBeAg was positive, in those with HBeAg negative 34 (30.6%)

had moderate-to-severe HAI and 38 (34.2%) had fibrosis ≥2. An ALT value of

≥58.5 U/l had higher sensitivity than that of 80 U/l in predicting

significant histological changes. Further, HAI and fibrosis were significantly

greater in the age of >30 years.

Conclusions:

We recommend liver biopsy in HBeAg-negative CHB over 30 years of age regardless

of ALT level and starting treatment at ALT 1.5 × ULN instead of 2 × ULN.

Document Type: Research article

DOI: 10.1111/j.1478-3231.2011.02491.x

Affiliations:1: Department of Hepatology, Bangabandhu Sheikh Mujib Medical

University, Dhaka, Bangladesh

Publication date: 2011-07-01

[Guest guest]

http://www.mdlinx.com/infectious-disease/newsl-article.cfm/3636193/ZZ68065536792\

5639220014/?news_id=497 & newsdt=061711 & subspec_id=130

Evaluation of normal or minimally elevated alanine transaminase, age and DNA

level in predicting liver histological changes in chronic hepatitis B

Liver International, 06/17/2011

Alam S et al. – This study recommends liver biopsy in HBeAg–negative chronic

hepatitis B(CHB) over 30 years of age regardless of Serum alanine

transaminase(ALT) level and starting treatment at ALT 1.5 × ULN instead of 2 x

ULN.

Methods • During the period of October 2006 to July 2009, 499 CHB patients

were included in this study with detectable hepatitis B virus(HBV) DNA at PCR.

• Of these, 181 had normal ALT, 200 had ALT [>(1 x ULN) <(2ULN)] and 118 had

ALT≥2ULN and were labelled as Group 1, 2 and 3 respectively.

Results • Strong positive correlation was found between ALT and histological

activity index (HAI) and fibrosis.

• However, 29 (52.7%) and five (9.1%) in Group 1 with positive HBeAg status

had HAI ≥4 and fibrosis ≥2 respectively.

• Among those with HBeAg-negative status, 66 (23.1%) had HAI >4 and 31 (10.8%)

had fibrosis ≥2.

• In Group 2, 14 (15.7%) had moderate-to-severe HAI and 19 (21.2%) had

fibrosis ≥2 when HBeAg was positive, in those with HBeAg negative 34 (30.6%)

had moderate-to-severe HAI and 38 (34.2%) had fibrosis ≥2.

• ALT value of ≥58.5U/l had higher sensitivity than that of 80U/l in

predicting significant histological changes.

• Further, HAI and fibrosis were significantly greater in the age of ≥30

years.

http://www.ingentaconnect.com/content/mksg/liv/2011/00000031/00000006/art00011

Evaluation of normal or minimally elevated alanine transaminase, age and DNA

level in predicting liver histological changes in chronic hepatitis B

Authors: Alam, Shahinul; Ahmad, Nooruddin; Mustafa, Golam; Shrestha, Ananta;

Alam, AKM Khorshed; Khan, Mobin

Source: Liver International, Volume 31, Number 6, July 2011 , pp. 824-830(7)

Publisher: Wiley-Blackwell

Abstract:

Background:

Serum alanine transaminase (ALT), hepatitis B virus (HBV) DNA level and age are

used in the evaluation of chronic hepatitis B (CHB). Aim:

We designed this study to evaluate liver histology with ALT and its relation

with age and HBV DNA.

Methods:

During the period of October 2006 to July 2009, 499 CHB patients were included

in this study with detectable HBV DNA at PCR. Of these, 181 had normal ALT, 200

had ALT [>(1 × ULN) <(2 ULN)] and 118 had ALT≥2 ULN and were labelled as

Group 1, 2 and 3 respectively.

Results:

A strong positive correlation was found between ALT and histological activity

index (HAI) and fibrosis. However, 29 (52.7%) and five (9.1%) in Group 1 with

positive HBeAg status had HAI ≥4 and fibrosis ≥2 respectively. Among those

with HBeAg-negative status, 66 (23.1%) had HAI >4 and 31 (10.8%) had fibrosis

≥2. In Group 2, 14 (15.7%) had moderate-to-severe HAI and 19 (21.2%) had

fibrosis ≥2 when HBeAg was positive, in those with HBeAg negative 34 (30.6%)

had moderate-to-severe HAI and 38 (34.2%) had fibrosis ≥2. An ALT value of

≥58.5 U/l had higher sensitivity than that of 80 U/l in predicting

significant histological changes. Further, HAI and fibrosis were significantly

greater in the age of >30 years.

Conclusions:

We recommend liver biopsy in HBeAg-negative CHB over 30 years of age regardless

of ALT level and starting treatment at ALT 1.5 × ULN instead of 2 × ULN.

Document Type: Research article

DOI: 10.1111/j.1478-3231.2011.02491.x

Affiliations:1: Department of Hepatology, Bangabandhu Sheikh Mujib Medical

University, Dhaka, Bangladesh

Publication date: 2011-07-01