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Paper Information

Journal:   HEPATITIS MONTHLY   MAY 2014 , Volume 14 , Number 5; Page(s) 0 To 0.
 
Paper: 

PROGNOSTIC VALUES OF FLUCTUATIONS IN SERUM LEVELS OF ALANINE TRANSAMINASE IN INACTIVE CARRIER STATE OF HBV INFECTION

 
 
Author(s):  FARZI HOSSEIN, EBRAHIMI DARYANI NASSER, MEHRNOUSH LEILA, SALIMI SHIMA, ALAVIAN SEYED MOAYED*
 
* MIDDLE EAST LIVER DISEASES CENTER (MELD), TEHRAN, IR IRAN
 
Abstract: 

Background: Current guidelines introduce periodic monitoring of serum alanine transaminase (ALT) as the first-line modality in follow-up patients, with a hepatitis B virus (HBV) inactive carrier state.
Objectives: This study aimed to determine the incidence rate and patterns of ALT fluctuations and prognostic values for the development of chronic HBV e antigen (HBeAg) -negative hepatitis B (CHB), HBV surface antigen (HBsAg) seroclearance, and liver-related complications.
Patients and Methods: Treatment-naïve patients with a chronic HBV infection, HBeAg (-) /HBeAb (+), normal ALT levels, and HBV DNA<2000 IU/mL, were followed-up every 6-12 months by assessing serum ALT levels. Serum HBV DNA was measured in cases of elevated ALT levels.
Results: A total of 399 patients were followed-up for 8.9 years; ALT>upper limit of normal (ULN, i.e.40 IU/L) was detected in 103 (25.8%) patients, with an annual incidence rate of 2.9%. ALT elevation was associated with; male gender, age, and higher serum ALT levels at study entry. Among the cases of ALT elevations, 16 (15.5%) patients had ALT levels>2 × ULN. There were 38 (36.9%) patients who had ALT levels that remained>ULN over six months, and 21 (20.4%) patients experienced at least two episodes of ALT elevations. In 15 (14.6%) patients, elevated ALT levels were associated with increased HBV replication (i.e. HBV DNA>2 000 IU/mL) and these were considered as CHB. However, elevation of ALT levels, even in the absence of HBV replication, increased the risk for the development of CHB up to 8-fold in prospective follow-ups. HBsAg seroclearance, cirrhosis, and hepatocellular carcinoma were detected in 43 (10.8%), 4 (1%), and 1 (0.25%) patients, respectively.
Conclusions: Fluctuations in serum ALT levels may change the prognosis of a HBV inactive carrier state.

 
Keyword(s): HEPATITIS B VIRUS, ALANINE TRANSAMINASE, HEPATITIS B E ANTIGEN, HEPATITIS B, CHRONIC
 
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