title: Patterns of viral load in chronic hepatitis B patients in Brazil and their association with ALT levels and HBeAg status.
abstract: Serum hepatitis B virus (HBV) DNA level is a predictor of the development of cirrhosis and hepatocellular carcinoma in chronic hepatitis B patients. Nevertheless, the distribution of viral load levels in chronic HBV patients in Brazil has yet to be described. This cross-sectional study included 564 participants selected in nine Brazilian cities located in four of the five regions of the country using the database of a medical diagnostics company. Admission criteria included hepatitis B surface antigen seropositivity, availability of HBV viral load samples and age >or=18 years. Males comprised 64.5% of the study population. Mean age was 43.7 years. Most individuals (62.1%) were seronegative for the hepatitis B e antigen (HBeAg). Median serum ALT level was 34 U/L. In 58.5% of the patients HBV-DNA levels ranged from 300 to 99,999 copies/mL; however, in 21.6% levels were undetectable. Median HBV-DNA level was 2,351 copies/mL. Over 60% of the patients who tested negative for HBeAg and in whom ALT level was less than 1.5 times the upper limit of the normal range had HBV-DNA levels > 2,000 IU/mL, which has been considered a cut-off point for indicating a liver biopsy and/or treatment. In conclusion, HBV-DNA level identified a significant proportion of Brazilian individuals with chronic hepatitis B at risk of disease progression. Furthermore, this tool enables those individuals with high HBV-DNA levels who are susceptible to disease progression to be identified among patients with normal or slightly elevated ALT.
authors.affiliation: Global Development and Medical Affairs, Bristol-Myers Squibb (BMS), São Paulo, Brazil. marcelo.nita@bms.com
authors.forename: Marcelo Eidi
authors.initials: ME
authors.lastname: Nita
authors.forename: Nelson
authors.initials: N
authors.lastname: Gaburo
authors.forename: Hugo
authors.initials: H
authors.lastname: Cheinquer
authors.forename: Gilbert
authors.initials: G
authors.lastname: L'Italien
authors.forename: Evaldo Stanislau
authors.initials: ES
authors.lastname: Affonso de Araujo
authors.forename: Patricia
authors.initials: P
authors.lastname: Mantilla
authors.forename: Nancy
authors.initials: N
authors.lastname: Cure-Bolt
authors.forename: Paulo A
authors.initials: PA
authors.lastname: Lotufo
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D001706:Biopsy; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004279:DNA, Viral / Q000097:blood; D018450:Disease Progression; D005260:Female; D006513:Hepatitis B e Antigens / Q000097:blood*; D006515:Hepatitis B virus / Q000235:genetics; D019694:Hepatitis B, Chronic / Q000097:blood* / Q000453:epidemiology / Q000821:virology*; D006801:Humans; D008099:Liver / Q000473:pathology; D008297:Male; D008875:Middle Aged; D019562:Viral Load
chemical_list: D004279:DNA, Viral; D006513:Hepatitis B e Antigens; D000410:Alanine Transaminase