Comparative study on guidelines in determining HBV phases in Iranian patients

Area of Science:

• Hepatology
• Virology
• Clinical Biochemistry

Background:

• The normal upper limit for alanine aminotransferase (ALT) in Hepatitis B virus (HBV) infection has been debated, with some guidelines lowering the previously accepted 40 IU/L threshold.
• This evolving understanding necessitates re-evaluation of patient classification based on ALT levels.

Purpose of the Study:

• To compare the classification of chronic Hepatitis B virus (HBV) infection phases using different alanine aminotransferase (ALT) normal value cutoffs.
• To assess the impact of varying ALT thresholds on patient categorization and potential treatment eligibility.

Main Methods:

• A cross-sectional study of 2000 HBsAg-positive patients was conducted between 2011 and 2018.
• Patients were classified into different phases of chronic HBV infection based on three guideline sets: AASLD, EASL/APASL, and ACG, which use distinct ALT cutoffs.
• The frequency distribution across these classifications was compared.

Main Results:

• In HBeAg-positive patients, the immune tolerance phase varied from 28% (ACG) to 68% (EASL/APASL) using different ALT cutoffs.
• For HBeAg-negative patients, the inactive carrier state ranged from 52.42% (ACG) to 82.89% (EASL/APASL).
• Lower ALT cutoffs (ACG and AASLD) resulted in a higher proportion of patients shifting from immune tolerance or inactive carrier states to the immune active phase.

Conclusions:

• The choice of ALT cutoff significantly influences the classification of chronic HBV infection phases.
• Lower ALT thresholds, particularly those from ACG and AASLD, may lead to more patients being classified as active HBV cases.
• This reclassification impacts treatment decisions, potentially increasing the number of patients eligible for antiviral therapy or requiring further investigation for liver damage.