title: Evaluation of normal or minimally elevated alanine transaminase, age and DNA level in predicting liver histological changes in chronic hepatitis B.
abstract: BACKGROUND
  Serum alanine transaminase (ALT), hepatitis B virus (HBV) DNA level and age are used in the evaluation of chronic hepatitis B (CHB).
  
  
  OBJECTIVE
  We designed this study to evaluate liver histology with ALT and its relation with age and HBV DNA.
  
  
  METHODS
  During the period of October 2006 to July 2009, 499 CHB patients were included in this study with detectable HBV DNA at PCR. Of these, 181 had normal ALT, 200 had ALT [>(1 × ULN) < (2 ULN)] and 118 had ALT ≥ 2 ULN and were labelled as Group 1, 2 and 3 respectively.
  
  
  RESULTS
  A strong positive correlation was found between ALT and histological activity index (HAI) and fibrosis. However, 29 (52.7%) and five (9.1%) in Group 1 with positive HBeAg status had HAI ≥4 and fibrosis ≥2 respectively. Among those with HBeAg-negative status, 66 (23.1%) had HAI >4 and 31 (10.8%) had fibrosis ≥2. In Group 2, 14 (15.7%) had moderate-to-severe HAI and 19 (21.2%) had fibrosis ≥2 when HBeAg was positive, in those with HBeAg negative 34 (30.6%) had moderate-to-severe HAI and 38 (34.2%) had fibrosis ≥2. An ALT value of ≥58.5 U/l had higher sensitivity than that of 80 U/l in predicting significant histological changes. Further, HAI and fibrosis were significantly greater in the age of >30 years.
  
  
  CONCLUSIONS
  We recommend liver biopsy in HBeAg-negative CHB over 30 years of age regardless of ALT level and starting treatment at ALT 1.5 × ULN instead of 2 × ULN.
authors.affiliation: Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. shahinul67@yahoo.com
authors.forename: Shahinul
authors.initials: S
authors.lastname: Alam
authors.forename: Nooruddin
authors.initials: N
authors.lastname: Ahmad
authors.forename: Golam
authors.initials: G
authors.lastname: Mustafa
authors.forename: Ananta
authors.initials: A
authors.lastname: Shrestha
authors.forename: A K M Khorshed
authors.initials: AK
authors.lastname: Alam
authors.forename: Mobin
authors.initials: M
authors.lastname: Khan
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000410:Alanine Transaminase / Q000097:blood*; D000704:Analysis of Variance; D001459:Bangladesh; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D016009:Chi-Square Distribution; D004796:Clinical Enzyme Tests; D004279:DNA, Viral / Q000097:blood*; D018450:Disease Progression; D005260:Female; D006515:Hepatitis B virus / Q000235:genetics*; D019694:Hepatitis B, Chronic / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008099:Liver / Q000473:pathology* / Q000821:virology; D008103:Liver Cirrhosis / Q000473:pathology* / Q000821:virology; D008297:Male; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D015854:Up-Regulation; D019562:Viral Load; D055815:Young Adult
chemical_list: D015415:Biomarkers; D004279:DNA, Viral; D000410:Alanine Transaminase