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Markers of disease activity in chronic hepatitis B virus infection
Kendal Yalcin1, Halil Degertekin, Fetin Yildiz
1Division of Hepatology, Dicle University School of Medicine, Diyarbakir, Turkey. kendaly@dicle.edu.tr
Insights
In chronic hepatitis B virus (HBV) infection, HBeAg-negative patients with high viral replication may have normal ALT levels but still show significant liver disease. Monitoring ALT is crucial for assessing damage and infectiousness in these HBV patients.
Area of Science:
- Hepatology
- Virology
- Immunology
Background:
- Chronic hepatitis B virus (HBV) infection management requires accurate disease activity assessment.
- Hepatitis B e antigen (HBeAg) status, HBV DNA levels, and alanine aminotransferase (ALT) are key markers.
- Emphasis on HBeAg-negative patients with high viral replication and normal or low ALT levels is crucial.
Purpose of the Study:
- To investigate the correlation between serum HBV DNA levels and clinical, virologic, and histologic parameters in chronic HBV patients.
- To specifically analyze HBeAg-negative patients with high HBV DNA replication but normal or low ALT levels.
- To evaluate the role of HBeAg status in disease activity and patient characteristics.
Main Methods:
- Prospective study of 179 consecutive chronic hepatitis B surface antigen carriers at a tertiary care center.
- Patients stratified into HBeAg-positive and HBeAg-negative groups, then further subdivided by HBV DNA and ALT levels.
- Clinical, virologic, and histologic data were analyzed in relation to HBeAg status.
Main Results:
- HBeAg-negative patients (33%) were older, had more male predominance, and lower HBV DNA levels than HBeAg-positive patients (67%).
- HBeAg status correlated significantly with age.
- Some anti-HBe-positive patients exhibited high viral replication with normal ALT and minimal histologic changes, indicating potential infectiousness despite seemingly mild disease.
Conclusions:
- Alanine aminotransferase (ALT) monitoring is valuable for assessing hepatocellular damage in chronic HBV infection.
- HBeAg-negative patients with elevated or normal ALT levels should be considered highly infectious.
- Disease activity in chronic HBV may not always correlate with ALT levels, especially in HBeAg-negative individuals.
Background:
Assessment of disease activity is important in the management of chronic hepatitis B virus (HBV) infection. Our objective was to study the correlation between serum HBV DNA levels and HBV e antigen (HBeAg) status, alanine aminotransferase (ALT) levels, histologic activity, age and sex in patients who had chronic HBV, with emphasis on those who were HBeAg negative with high replication but had normal or below-normal liver enzyme levels and mild liver disease.
Method:
At our university-affiliated tertiary care medical centre in Turkey, we studied prospectively 179 consecutive patients who were long-term hepatitis B surface antigen carriers. These patients were first separated into 2 groups according to HBeAg positivity and then subdivided into 4 groups according to the presence of HBV DNA, HBeAg status and ALT levels. The clinical, virologic and histologic differences in these patients were evaluated with respect to the HBeAg status.
Results:
Of the 179 patients, 120 (67%) were HBeAg positive and 59 (33%) were HBeAg negative. The mean (and standard deviation) age in the former group was 24.8 (7.60) and in the latter group was 32.2 (11.2) years (p < 0.001). HBeAg-negative patients had significantly more severe liver disease, more male predominance and lower serum HBV DNA levels than HBeAg-positive patients (p < 0.05). HBeAg status had a close correlation with age. There was a significant correlation between age and serum HBV DNA levels but not between HBV DNA levels and disease activity in study groups. We found that some of anti-HBe-positive patients had below-normal ALT levels with minimal or absent histologic changes despite high viral replication.
Conclusions:
Monitoring of ALT is of value in assessing hepatocellular damage in patients with chronic hepatitis B virus infection. HBeAg-negative patients with elevated ALT levels and some with normal ALT levels should be considered highly infectious in the course of chronic HBV infection.