title: Hepatitis B inactive carriers: clinical course and outcomes.
abstract: OBJECTIVE
  Hepatitis B virus (HBV) inactive carriers are HBV e antigen (HBeAg)-negative patients with normal alanine aminotransferase (ALT) levels and HBV DNA of ≤ 10000 copies/mL. We aimed to determine the clinical impact of ALT and HBV DNA elevations during the course of HBV infection.
  
  
  METHODS
  From January 1989 to January 2012, 146 inactive carriers were prospectively followed every 6-12 months with ALT and HBV DNA measurements and with hepatocellular carcinoma (HCC) surveillance.
  
  
  RESULTS
  During the follow-up of 8 ± 6.3 years, 56 of the 146 patients maintained ALT ≤ 40 U/L and HBV DNA ≤ 10000 copies/mL. However, 39 had rises of ALT > 40-80 U/L and 4 had ALT > 80 U/L; all except one reverted to baseline values. Also, during follow up, 69 (47.3%) inactive carriers had increases in HBV DNA of > 10000-999999 copies/mL; 38 of these patients' HBV DNA returned to baseline levels, while the remaining 31 patients maintained elevated HBV DNA values but had corresponding ALT of ≤ 40 U/L. There were four liver-related outcomes: 129 (88.4%) remained "inactive carriers", 13 (8.9%) had loss of hepatitis B surface antigen (HBsAg), one (0.7%) had a spontaneous reactivation to HBeAg-negative chronic hepatitis, and two (1.4%) developed HCC.
  
  
  CONCLUSIONS
  Although the prognosis of inactive carrier is favorable, transient ALT and HBV DNA elevations may be observed but have minimal clinical significance. Moreover, continuous HCC surveillance remains necessary since the risk of development still exists.
authors: Liver Center, Huntington Medical Research Institutes, Pasadena, California 91105, USA. myrontong@hmri.org
authors: Myron J
authors: MJ
authors: Tong
authors: Judy
authors: J
authors: Trieu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000209:etiology; D002353:Carrier State / Q000503:physiopathology / Q000821:virology*; D002648:Child; D004279:DNA, Viral / Q000097:blood*; D005260:Female; D006509:Hepatitis B / Q000150:complications / Q000503:physiopathology / Q000821:virology*; D006514:Hepatitis B Surface Antigens / Q000032:analysis*; D006513:Hepatitis B e Antigens / Q000032:analysis*; D006801:Humans; D008113:Liver Neoplasms / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D006513:Hepatitis B e Antigens; D000410:Alanine Transaminase