Significant hepatic histopathology in chronic hepatitis B patients with serum ALT less than twice ULN and high HBV-DNA levels in Indonesia

• Published in: Journal of digestive diseases 2011-12, Vol.12 (6), p.476-480
• Main Authors: LESMANA, C. Rinaldi A., GANI, Rino A., HASAN, Irsan, SIMADIBRATA, Marcellus, SULAIMAN, Andri S., PAKASI, Levina S., BUDIHUSODO, Unggul, KRISNUHONI, Ening, LESMANA, Laurentius A.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Alanine Transaminase - blood; Biopsy; chronic hepatitis B; DNA, Viral - blood; Female; Genotype; Hepatitis B e Antigens - blood; Hepatitis B virus; Hepatitis B virus - genetics; Hepatitis B, Chronic - blood; Hepatitis B, Chronic - ethnology; Hepatitis B, Chronic - pathology; Human immunodeficiency virus; Humans; Incidence; Indonesia; Liver - pathology; Liver - virology; Liver Cirrhosis - blood; Liver Cirrhosis - ethnology; Liver Cirrhosis - pathology; Male; Middle Aged; normal alanine aminotransferase; Prospective Studies; Retrospective Studies; Severity of Illness Index; significant liver histopathology; Young Adult
• ISSN: 1751-2972; 1751-2980
• DOI: 10.1111/j.1751-2980.2011.00540.x

OBJECTIVE:  To study the prevalence of significant hepatic histopathology in chronic hepatitis B (CHB) patients with alanine aminotransferase (ALT) ≤ twice upper limit of normal (ULN) and its association with age, HBeAg status, hepatitis B virus (HBV)‐DNA level and viral genotype. METHODS:  A prospective study was conducted over a 3‐year period in treatment‐naive CHB patients with ALT ≤ twice ULN. Patients with a history of acute flare hepatitis, use of alcohol and hepatotoxic drugs, hepatitis C, hepatitis D and human immunodeficiency virus (HIV) co‐infection were excluded from the study. Hepatic histopathology was assessed according to the METAVIR scoring system. RESULTS:  A total of 145 patients were recruited, 81 (55.9%) of whom were male. The patients’ mean age was 41.50 ± 10.74 years (range 16–70 years). Significant hepatic inflammation was found in 59.3% of these patients, and significant hepatic fibrosis was found in 62.1%, the latter being associated with hepatitis B e antigen status, ALT levels and serum HBV‐DNA, but not with their age group or viral genotype. Significant hepatic fibrosis was found in 24 of 35 CHB patients (68.6%) who were previously considered in an immunotolerance phase. CONCLUSIONS  The prevalence of significant hepatic histopathology in CHB patients with serum ALT levels ≤ twice ULN is high. Delayed antiviral treatment can be harmful.