title: Longitudinal observation of viral load changes in untreated HBeAg negative chronic hepatitis B.
abstract: BACKGROUND
  An HBV DNA level of 2000 IU/ml has been used to differentiate HBeAg negative chronic hepatitis B from the inactive carrier state. We sought to examine the nature and frequency of fluctuations in viral load and ALT around this threshold.
  
  
  METHODS
  A retrospective review of St Vincent's Hospital database was performed to identify patients who had been observed, untreated, with HBV DNA and ALT levels over a period of at least 18 months.
  
  
  RESULTS
  27 HBeAg negative patients with HBV DNA < 2000 IU/ ml at baseline (Group 1) and 20 HBeAg negative patients with HBV DNA > or = 2000 IU/ml (Group 2) were identified. Of group 1 patients, only 8/27 had persistently normal ALT and HBV DNA persistently <2000 IU/ml over a median followup of 24 months. 11/27 (41%) Group 1 patients showed fluctuations above 2000 IU/ml over a median of 24 months followup, most of which were transient and in the range <20,000 IU/ml. They were accompanied by persistently normal ALT in 5/11 (45%). 8 of 20 (40%) Group 2 patients had a drop of HBV DNA to <2000 IU/ml over followup. These had a significantly lower baseline HBV DNA (8610 v/s 208763, p = 0.03) than those that remained persistently >2000 IU/ml.
  
  
  CONCLUSIONS
  Minor fluctuations in HBV DNA up to 20,000 IU/ ml, accompanied by persistently normal ALT occur frequently in HBeAg negative chronic hepatitis B.
authors.affiliation: Department of Gastroenterology. St Vincent's Hospital, Fitzroy, Victoria, Australia. Catherine.Croagh@svhm.org.au
authors.forename: Catherine M N
authors.initials: CM
authors.lastname: Croagh
authors.forename: Sally J
authors.initials: SJ
authors.lastname: Bell
authors.forename: Robert Y
authors.initials: RY
authors.lastname: Chen
authors.forename: Stephen
authors.initials: S
authors.lastname: Locarnini
authors.forename: Paul V
authors.initials: PV
authors.lastname: Desmond
mesh_terms: D000328:Adult; D002353:Carrier State; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D005500:Follow-Up Studies; D006513:Hepatitis B e Antigens / Q000276:immunology*; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology*; D019694:Hepatitis B, Chronic / Q000276:immunology* / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012698:Serologic Tests; D019562:Viral Load / Q000276:immunology*
chemical_list: D004279:DNA, Viral; D006513:Hepatitis B e Antigens