title: Viral and host factors related with histopathologic activity in patients with chronic hepatitis B and moderate or intermittently elevated alanine aminotransferase levels.
abstract: OBJECTIVE
  viral and host factors are related with progression of pathological lesion in chronic hepatitis B. We analyzed these factors in patients with moderate or intermittently elevated ALT levels, and its threshold that determinate significant histological activity.
  
  
  METHODS
  retrospective analyses of viral and host parameters in 89 consecutive chronic hepatitis B patients biopsied because of moderate or intermittently elevated ALT levels [1-2 x ULN (ULN = 39 IU/ml)] and/or DNA-HBV > 2 x 10³ IU/ml in AntiHBe+ patients. It was analyzed age, gender, ALT levels, HBeAg, viral load and genotype. It was considered advanced histological lesion a Knodell Score (KS) > 7 and histological lesion indicating treatment, lobular inflammation ≥2 or fibrosis ≥2 according to Scheuer Classification.
  
  
  RESULTS
  KS > 7 and histological lesion indicating treatment was found in 47.8 and 60.7% respectively. It was observed relationship between age, male gender, ALT levels and viral load with histological damage (p < 0.05). Frequency of advanced lesion indicating treatment was upper in patients with ALT levels > ULN (69.1 vs. 47.1%, p = 0.04). There were not significant upper frequencies of advanced lesion when a cut-off of 40 years or DNA-HBV > 2 x 10³ IU/ml viral load or serological status HBeAg was considerate. Histological activity was lesser in genotype D patients than those infected with others genotypes (p < 0.05).
  
  
  CONCLUSIONS
  upper frequency of advanced histological lesion in chronic hepatitis B patients with moderate or intermittently elevated ALT levels make recommended liver biopsy, independent of viral load and serological status HBeAg. Other factors like age, gender or genotype can help to indicate biopsy in individual cases.
authors.affiliation: Service of Digestive Diseases, Hospital Clínico Universitario de Santiago de Compostela, A Coruña, Spain. esther.molina.perez@sergas.es
authors.forename: E
authors.initials: E
authors.lastname: Molina-Pérez
authors.forename: J F
authors.initials: JF
authors.lastname: Castroagudín
authors.forename: A
authors.initials: A
authors.lastname: Aguilera-Guirao
authors.forename: E
authors.initials: E
authors.lastname: Otero-Antón
authors.forename: S
authors.initials: S
authors.lastname: Tomé-Martínez-de-Rituerto
authors.forename: J
authors.initials: J
authors.lastname: Mera-Calviño
authors.forename: J J
authors.initials: JJ
authors.lastname: Rodríguez-Calviño
authors.forename: J E
authors.initials: JE
authors.lastname: Domínguez-Muñoz
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D005260:Female; D019694:Hepatitis B, Chronic / Q000097:blood* / Q000473:pathology* / Q000821:virology; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D000410:Alanine Transaminase