Evaluation of serum HBV viral load, transaminases and histological features in chronic HBeAg-negative hepatitis B patients
Gastroenterology and Hepatology from Bed to Bench,
Vol. 10 No. 1 (2017),
11 Bahman 2017
,
Page 39-43
https://doi.org/10.22037/ghfbb.v0i0.909
Abstract
Introduction: Chronic hepatitis B infection (CHB) is a major global health problem. Hepatitis B e antigen (HBeAg)-negative is a common type of CHB in Iran. Liver damage in HBeAg-negative CHB leads to progressive form of the liver disease with poor prognosis. Therefore, it seems necessary to perform a comprehensive evaluation of different spectrum of laboratory measurements accompanying histological findings. The aim of this study was to evaluate the association between the biochemical, virologic and histologic features in HBeAg-negative CHB. Furthermore, we assessed the application of new cut-off values for alanine aminotransferase in HBeAg-negative CHB patients.
Materials and methods: HBeAg- negative CHB patients referring to hepatology clinics at Ghaem and Imam Reza hospitals during two years period were enrolled. Patients with alcohol consumption, liver mass, fatty liver and whom with positive results of Anti HDV, Anti HCV or Anti HIV were excluded. Liver enzymes were requested and Hepatitis B viral loads were measured by real time polymerase chain reaction (RT-PCR) in all patients. Liver biopsies were assessed by two expert pathologists. The relationship between viral loads, liver enzymes and histopathological features was analyzed using descriptive and analytic statistical methods.
Results: One hundred and fifty HBeAg-negative and HBe Ab-positive CHB patients (males=110, mean age=38.44±11.34 years) were assessed. Serum ALT levels had a significant relation with the logarithm of serum HBV-DNA levels (P<0.0001), grade and stage on liver biopsy (P<0.001, P=0.034, respectively). Serum viral load, AST and ALT levels were independent predictors of histological grade, but age was the only independent predictor of the stage of liver fibrosis. There was a significant relationship between serum ALT levels and stage of liver fibrosis (P<0.0001) when the new cutoff values for ALT were taken into account.
We also found that age had a significant relation with histological grade but it showed a reverse relation with alanine aminotransferase (ALT) levels (P=0.009).
Conclusions: In HBeAg-negative CHB patients, serum AST levels had a better predicting value for liver necrosis and inflammation. Moreover, age could be regarded as an independent predictor of the stage of liver fibrosis. This study revealed that the new cutoff values for ALT had superiority over the conventional values to identify patients with a higher risk of liver fibrosis.
Keywords: Hepatitis B, HBeAg, grade, stage, viral load, AST, ALT
- Hepatitis B
- HBeAg
- grade
- stage
- viral load
- AST
- ALT
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References
References
Wright TL. Introduction to chronic hepatitis B infection. The American journal of gastroenterology. 2006;101 Suppl 1:S1-6. PubMed PMID: 16448446.
Mast EE, Margolis HS, Fiore AE, Brink EW, Goldstein ST, Wang SA, et al. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) part 1: immunization of infants, children, and adolescents. MMWR Recommendations and reports : Morbidity and mortality weekly report Recommendations and reports / Centers for Disease Control. 2005 Dec 23;54(RR-16):1-31. PubMed PMID: 16371945.
Organization WH. Introduction of hepatitis B vaccine into childhood immunization services: Management guidelines, including information for health workers and parents. 2001.
Jalali MV, Alavian SM. Hepatitis B e Antigen-Negative Chronic Hepatitis B. Hepatitis monthly. 2006;6(1):31-5.
Bita Behnava M, Shervin Assari M, Mohsen Amini M, Bashir Hajibeigi M, Seyed-Moayed Alavian M. HBV DNA viral load and chronic hepatitis infection in different stages. Hepatitis monthly. 2005;5(4):123-7.
Hadziyannis SJ, Vassilopoulos D. Immunopathogenesis of hepatitis B e antigen negative chronic hepatitis B infection. Antiviral research. 2001 Nov;52(2):91-8. PubMed PMID: 11672818.
Hadziyannis SJ. Treatment paradigms on hepatitis B e antigen-negative chronic hepatitis B patients. Expert opinion on investigational drugs. 2007 Jun;16(6):777-86. PubMed PMID: 17501691.
Chu CJ, Hussain M, Lok AS. Quantitative serum HBV DNA levels during different stages of chronic hepatitis B infection. Hepatology. 2002 Dec;36(6):1408-15. PubMed PMID: 12447866.
Laras A, Koskinas J, Avgidis K, Hadziyannis SJ. Incidence and clinical significance of hepatitis B virus precore gene translation initiation mutations in e antigen-negative patients. Journal of viral hepatitis. 1998 Jul;5(4):241-8. PubMed PMID: 9751010.
Hadziyannis SJ, Papatheodoridis GV. Hepatitis B e antigen-negative chronic hepatitis B: natural history and treatment. Seminars in liver disease. 2006 May;26(2):130-41. PubMed PMID: 16673291.
Bonino F, Rosina F, Rizzetto M, Rizzi R, Chiaberge E, Tardanico R, et al. Chronic hepatitis in HBsAg carriers with serum HBV-DNA and anti-HBe. Gastroenterology. 1986 May;90(5 Pt 1):1268-73. PubMed PMID: 3956945.
Fattovich G. Natural history and prognosis of hepatitis B. Seminars in liver disease. 2003 Feb;23(1):47-58. PubMed PMID: 12616450.
Merat S, Malekzadeh R, Rezvan H, Khatibian M. Hepatitis B in Iran. Arch Iranian Med. 2000;3(4):192-201.
Wu WC, Wu CY, Wang YJ, Hung HH, Yang HI, Kao WY, et al. Updated thresholds for serum alanine aminotransferase level in a large-scale population study composed of 34 346 subjects. Alimentary pharmacology & therapeutics. 2012;36(6):560-8.
Prati D, Taioli E, Zanella A, Della Torre E, Butelli S, Del Vecchio E, et al. Updated definitions of healthy ranges for serum alanine aminotransferase levels. Annals of internal medicine. 2002 Jul 2;137(1):1-10. PubMed PMID: 12093239. Epub 2002/07/03. eng.
Kim HC, Nam CM, Jee SH, Han KH, Oh DK, Suh I. Normal serum aminotransferase concentration and risk of mortality from liver diseases: prospective cohort study. BMJ (Clinical research ed). 2004 Apr 24;328(7446):983. PubMed PMID: 15028636. Pubmed Central PMCID: PMC404493. Epub 2004/03/19. eng.
Ljunggren KK, Nordenfelt E, Kidd A. Correlation of HBeAg/anti-HBe, ALT levels, and HBV DNA PCR results in HBsAg-positive patients. Journal of medical virology. 1993 Apr;39(4):297-302. PubMed PMID: 8492102. Epub 1993/04/01. eng.
Rabbi FJ, Rezwan MK, Shirin T. HBeAg/anti-HBe, alanine aminotransferase and HBV DNA levels in HBsAg positive chronic carriers. Bangladesh Medical Research Council bulletin. 2008 Aug;34(2):39-43. PubMed PMID: 19119537. Epub 2009/01/06. eng.
Hasanjani Roushan MR, Hajiahmadi M, Shafaie S. Histopathological features of liver and its relation to serum transaminase levels in 91 cases of anti-HBe-positive chronic hepatitis B. International journal of clinical practice. 2005 Jul;59(7):791-4. PubMed PMID: 15963206. Epub 2005/06/21. eng.
Wang ZL, Liu WP, Wang GQ. [Relationship among pathological changes in liver tissues and level of serum ALT, virology of patients with chronic HBV infection]. Zhonghua shi yan he lin chuang bing du xue za zhi = Zhonghua shiyan he linchuang bingduxue zazhi = Chinese journal of experimental and clinical virology. 2008 Oct;22(5):388-90. PubMed PMID: 19469184. Epub 2009/05/28. chi.
Shao J, Wei L, Wang H, Sun Y, Zhang LF, Li J, et al. Relationship between hepatitis B virus DNA levels and liver histology in patients with chronic hepatitis B. World journal of gastroenterology : WJG. 2007 Apr 14;13(14):2104-7. PubMed PMID: 17465456. Epub 2007/05/01. eng.
Kim KH, Na IH, Cha JM, Cho YK, Park SY, Kim HP, et al. [Serum ALT and HBV DNA levels in patients with HBeAg-negative chronic hepatitis B]. Taehan Kan Hakhoe chi = The Korean journal of hepatology. 2003 Dec;9(4):284-92. PubMed PMID: 14695695. Epub 2003/12/27. kor.
Manesis EK, Papatheodoridis GV, Hadziyannis SJ. Serum HBV-DNA levels in inactive hepatitis B virus carriers. Gastroenterology. 2002 Jun;122(7):2092-3; author reply 3. PubMed PMID: 12055617. Epub 2002/06/11. eng.
Ying RS, Yang Z, Chen YY, Yang KL, Xiao YH, Wu LJ, et al. [Differential liver histopathological features of chronic HBV infection patients with normal and mildly elevated serum ALT]. Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology. 2012 Aug;20(8):585-8. PubMed PMID: 23207151. Epub 2012/12/05. chi.
Alam S, Ahmad N, Mustafa G, Shrestha A, Alam AK, Khan M. Evaluation of normal or minimally elevated alanine transaminase, age and DNA level in predicting liver histological changes in chronic hepatitis B. Liver international : official journal of the International Association for the Study of the Liver. 2011 Jul;31(6):824-30. PubMed PMID: 21645213. Epub 2011/06/08. eng.
Lin CL, Liao LY, Liu CJ, Yu MW, Chen PJ, Lai MY, et al. Hepatitis B viral factors in HBeAg-negative carriers with persistently normal serum alanine aminotransferase levels. Hepatology. 2007 May;45(5):1193-8. PubMed PMID: 17464993. Epub 2007/04/28. eng.
Yuen MF, Yuan HJ, Wong DK, Yuen JC, Wong WM, Chan AO, et al. Prognostic determinants for chronic hepatitis B in Asians: therapeutic implications. Gut. 2005 Nov;54(11):1610-4. PubMed PMID: 15871997. Pubmed Central PMCID: PMC1774768. Epub 2005/05/06. eng.
Lai M, Hyatt BJ, Nasser I, Curry M, Afdhal NH. The clinical significance of persistently normal ALT in chronic hepatitis B infection. J Hepatol. 2007 Dec;47(6):760-7. PubMed PMID: 17928090. Epub 2007/10/12. eng.
Assy N, Beniashvili Z, Djibre A, Nasser G, Grosovski M, Nseir W. Lower baseline ALT cut-off values and HBV DNA levels better differentiate HBeAg- chronic hepatitis B patients from inactive chronic carriers. World journal of gastroenterology : WJG. 2009 Jun 28;15(24):3025-31. PubMed PMID: 19554656. Pubmed Central PMCID: PMC2702111. Epub 2009/06/26. eng.
Ijaz B, Ahmad W, Javed FT, Gull S, Hassan S. Revised cutoff values of ALT and HBV DNA level can better differentiate HBeAg (-) chronic inactive HBV patients from active carriers. Virology journal. 2011;8:86. PubMed PMID: 21352567. Pubmed Central PMCID: PMC3052190. Epub 2011/03/01. eng.
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