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Alloveda Liver Update: Histological Changes and Antiviral Efficacy in Chronic Hepatitis B Virus Infection Patients with Normal Alanine Aminotransferase

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eMediNexus    29 July 2020

A proportion of chronic hepatitis B virus (HBV) infection patients with normal alanine aminotransferase (ALT) should start antiviral therapy on the basis of liver biopsy. A study was designed to ascertain the proportion of such patients, determine noninvasive methods for identifying and evaluate antiviral efficacy.

Overall, 253 patients of chronic HBV infection with normal ALT levels were assessed at baseline and 57 patients with histological indication for antiviral therapy (Histology activity index ≥5 and/or Ishak fibrosis score ≥3) and 140 patients with raised ALT levels were given entecavir therapy and were followed-up to 78 weeks with a second liver biopsy.

About 50.2% of the 253 patients with normal ALT fulfilled histological indication for antiviral therapy. Aspartate aminotransferase (P=0.049), anti-hepatitis B virus core antibody (P=0.001) and liver stiffness measurement (P=0.000) were found to be independent variables to identify histological indication for antiviral therapy. A noninvasive model (AAF) was the best among the independent variables and other noninvasive models, with area under the operating characteristic curve of 0.887. Antiviral efficacy revealed that 38 of 57 patients (66.7%) had undetectable HBV DNA. Twelve of 29 patients (41.4%) who were hepatitis B e antigen (HBeAg)-positive at baseline attained HBeAg loss while 3 (10.3%) demonstrated HBeAg seroconversion. Histological response was seen in 25 of 57 patients (43.9%). In addition, 57 patients with normal ALT had a similar antiviral efficacy as 140 patients with elevated ALT (P>0.1), except for the fraction of inflammation improvement and histological response (P=0.005, P=0.049).

It was thus concluded that half of chronic HBV patients with normal ALT should initiate antiviral therapy on the basis of liver biopsy. A noninvasive model could serve as a reliable tool for antiviral treatment decision. Patients with normal or elevated ALT seem to have similar antiviral efficacy.

Source: Wu Z, Ma A-L, Xie Q, et al. Significant Histological Changes and Satisfying Antiviral Efficacy in Chronic Hepatitis B Virus Infection Patients with Normal Alanine Aminotransferase. Antiviral Therapy Decision in Chronic HBV Patients with Normal ALT. Clin Res Hepatol Gastroenterol. 2020 Jun 19;S2210-7401(20)30156-X.

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