Evaluation of liver biopsy in Egyptian HBeAg-negative chronic hepatitis B patients at initial presentation: implications for therapy.
OBJECTIVE
A subgroup of HBeAg-negative chronic hepatitis B (CHB) patients with alanine aminotransferase (ALT) and/or hepatitis B virus (HBV)-DNA levels below the cutoff values of international guidelines may have significant liver disease and miss the opportunity for early treatment. Histopathological changes of HBeAg-negative CHB patients at initial presentation irrespective of HBV-DNA and/or ALT levels to increase the likelihood of patients for treatment are evaluated.


METHODS
CHB patients attending Cairo Liver Center from January 2006 to May 2008 had biochemical, serological, and virological screening as well as liver biopsy that was assessed by Metavir score.


RESULTS
Fifty-two HBeAg-negative CHB patients (46 male and 6 female) with a median age of 37.5 years were included in the study. Significant fibrosis (>or=F2) was found in 26% (5/19) of patients with serum HBV-DNA <2,000 IU/ml, and 53% (21/40) of patients with ALT level <2xULN. Liver biopsy increased candidacy for treatment by nearly 25% before implementation of the recommended lower ALT levels (30 U/l for male and 19 U/l for female patients), and by 21.2% after implementation of the lower ALT level. Implementation of the lower ALT level increased the candidacy of patients for treatment by 4% (two patients), whereas liver biopsy increased eligibility for treatment by 55.8 % (27/49).


CONCLUSIONS
Liver biopsy is more reliable than either ALT or HBV-DNA levels in the decision to treat Egyptian HBeAg-negative CHB patients, even with the implementation of the recommended lower ALT levels.
El-Zayadi
Abdel-Rahman
AR
Department of Tropical Medicine, Ain Shams University, Cairo, Egypt. clcz@tedata.net.eg
Badran
Hanaa Mostafa
HM
Saied
Ahmed
A
Shawky
Sherine
S
Attia
Mohy El-Deen
Mel-D
Zalata
Khaled
K
D000328:Adult; D001707:Biopsy, Needle / Q000379:methods*; D004279:DNA, Viral / Q000032:analysis; D003937:Diagnosis, Differential; D004534:Egypt / Q000453:epidemiology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006513:Hepatitis B e Antigens / Q000276:immunology*; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology*; D019694:Hepatitis B, Chronic / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology*; D006801:Humans; D015994:Incidence; D007372:Interferons / Q000627:therapeutic use*; D008099:Liver / Q000473:pathology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D015995:Prevalence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D055815:Young Adult
D004279:DNA, Viral; D006513:Hepatitis B e Antigens; D007372:Interferons