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[Risk factors associated with the progression of chronic HBV infection in patients with normal ALT]

L Wei1, H Li1, P Hu1

  • 1Institute for Viral Hepatitis, Chongqing Medical University; Key Laboratory of Molecular Biology for Infectious Diseases, Ministry of Education; Department of Infection, The Second Affiliated Hospital of Chongqing Medical University,400010, China.

Zhonghua Gan Zang Bing Za Zhi = Zhonghua Ganzangbing Zazhi = Chinese Journal of Hepatology
|December 6, 2021
PubMed

Insights

Chronic Hepatitis B patients with normal ALT levels may still face significant liver disease progression. This review highlights insidious risk factors in these patients, emphasizing the need for careful monitoring beyond standard liver enzyme tests.

Area of Science:

  • Hepatology
  • Virology
  • Gastroenterology

Background:

  • Chronic Hepatitis B virus (HBV) infection is a major cause of chronic liver disease in China.
  • Antiviral therapy reduces risks of end-stage liver disease, including cirrhosis, liver failure, and liver cancer.
  • Current guidelines recommend regular follow-up for chronic Hepatitis B patients, even with normal alanine aminotransferase (ALT) levels.

Purpose of the Study:

  • To review insidious risk factors for chronic HBV progression in patients presenting with normal ALT levels.
  • To highlight the discrepancy between normal ALT and underlying liver damage in chronic HBV.
  • To inform clinical practice regarding the management of chronic Hepatitis B patients with normal liver enzymes.

Main Methods:

  • Literature review of studies on chronic Hepatitis B patients with normal ALT levels.
  • Analysis of hepatic histopathology findings in relation to ALT levels.
  • Identification and summarization of risk factors associated with disease progression.

Main Results:

  • A significant percentage of chronic HBV patients (25.4%-88.9%) exhibit normal ALT levels.
  • Despite normal ALT, these patients can have substantial liver inflammation, fibrosis (G≥2 and/or S≥2), cirrhosis, and hepatocellular carcinoma.
  • Several insidious risk factors contribute to disease progression in this cohort.

Conclusions:

  • Normal ALT levels in chronic Hepatitis B patients do not exclude significant liver disease.
  • Regular monitoring and assessment of histopathological changes are crucial for patients with normal ALT.
  • Understanding and addressing insidious risk factors are vital for preventing end-stage liver disease in chronic HBV.

Keywords:
Alanine aminotransferaseHepatitis B, chronicHepatocellular carcinomaRisk factors

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