title: The clinical significance of persistently normal ALT in chronic hepatitis B infection.
abstract: OBJECTIVE
  Chronic hepatitis B virus (HBV) disease is caused by both necroinflammation and active viral replication. The role of ALT levels as a predictor of liver injury has recently been questioned. The aim of the study was to determine whether normal ALT is associated with liver injury in a cohort of HBV patients undergoing liver biopsy.
  
  
  METHODS
  This is a retrospective review of chronic HBV patients divided into 3 groups; (1) persistently normal ALT (PNALT); (2) ALT 1-1.5X ULN and (3) ALT>1.5X ULN. Multiple clinical, biochemical, virological variables were evaluated.
  
  
  RESULTS
  One hundred and ninety-two patients met the inclusion criteria, 59 with PNALT, 26 with ALT 1-1.5X ULN, and 107 with ALT>1.5X ULN. Increasing age, higher ALT, higher grade of inflammation on biopsy, and HBeAg positivity predicted fibrosis. 18% of patients with PNALT had stage 2+ fibrosis and 34% had grade 2 or 3 inflammation. Overall 37% of patients with PNALT had significant fibrosis or inflammation. Subgroup analysis showed the majority with fibrosis belonged to the high normal ALT group and that only a minority who were young and immune tolerant had significant findings on biopsy.
  
  
  CONCLUSIONS
  There is significant fibrosis and inflammation in 37% of patients with PNALT and a liver biopsy should be considered in patients older than 40 with high normal ALT.
authors.affiliation: Beth Israel Deaconess Medical Center, Division of Hepatology, Harvard Medical School, Boston, MA, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Lai
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Hyatt
authors.forename: Imad
authors.initials: I
authors.lastname: Nasser
authors.forename: Michael
authors.initials: M
authors.lastname: Curry
authors.forename: Nezam H
authors.initials: NH
authors.lastname: Afdhal
mesh_terms: D000328:Adult; D000367:Age Factors; D000410:Alanine Transaminase / Q000032:analysis*; D001706:Biopsy; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D005260:Female; D006513:Hepatitis B e Antigens / Q000032:analysis; D019694:Hepatitis B, Chronic / Q000473:pathology*; D006801:Humans; D007249:Inflammation; D008103:Liver Cirrhosis / Q000175:diagnosis*; D008297:Male; D011237:Predictive Value of Tests; D044469:Racial Groups; D012189:Retrospective Studies
chemical_list: D006513:Hepatitis B e Antigens; D000410:Alanine Transaminase