Chronic hepatitis B virus carriers in the immunotolerant phase of infection: histologic findings and outcome.
OBJECTIVE
The indication for histologic evaluation of the liver is controversial for patients in the immunotolerant phase of chronic hepatitis B virus (HBV) infection.


METHODS
Results of liver biopsy examination and follow-up evaluation were assessed retrospectively in 40 patients who satisfied the following criteria: presence of hepatitis B surface antigen and hepatitis B e antigen, HBV DNA level greater than 10(7) cp/mL, normal alanine aminotransferase level, absence of co-infection with other viruses, and absence of antiviral or immunosuppressive treatment.


RESULTS
On liver biopsy examination, according to the Metavir scoring system, fibrosis was absent in 20 patients, and mild (F1) in 20 patients. During a median follow-up period of 37.7 months in 31 patients, loss of tolerance was observed at a median age of 30.7 years in 12 (38%): 6 had transition to inactive disease, 3 developed chronic hepatitis, and 3 had a transient increase of alanine aminotransferase levels. Among baseline characteristics, only alanine aminotransferase levels were significantly higher in patients with subsequent loss of tolerance.


CONCLUSIONS
In patients in the immunotolerant phase of chronic HBV infection, liver biopsy examination shows only minimal changes and probably is unnecessary. Loss of tolerance, occurring at a median age of 30.7 years, is characterized by a rapid transition to an inactive carrier state in two thirds of patients, and to chronic hepatitis in one third of patients.
Andreani
Tony
T
Assistance Publique-Hôpitaux de Paris, Hôpital Saint Antoine, Service d'Hépatologie, Paris, France.
Serfaty
Lawrence
L
Mohand
Djamila
D
Dernaika
Salem
S
Wendum
Dominique
D
Chazouillères
Olivier
O
Poupon
Raoul
R
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002353:Carrier State / Q000097:blood / Q000276:immunology* / Q000473:pathology*; D015331:Cohort Studies; D005260:Female; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006513:Hepatitis B e Antigens / Q000097:blood; D019694:Hepatitis B, Chronic / Q000097:blood / Q000276:immunology* / Q000473:pathology*; D006801:Humans; D007108:Immune Tolerance; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019562:Viral Load
D006514:Hepatitis B Surface Antigens; D006513:Hepatitis B e Antigens