title: Clinical presentation and disease phases of chronic hepatitis B using conventional versus modified ALT criteria in Asian Americans.
abstract: OBJECTIVE
  The modified normal alanine aminotransferase (ALT) value (i.e., males <30 and females <19 IU/L) is a better criteria associated with histological activity in chronic hepatitis B (CHB). This study was aimed to assess if the modified ALT criteria could be better associated with disease phases in a cohort of Asian Americans (AsAm) with CHB.
  
  
  METHODS
  This two-center retrospective study evaluated 198 non-treated AsAm with CHB and a mean follow-up of 21 months. Both conventional and modified ALT criteria were used to determine the differences and clinical value using modified ALT criteria in classifying CHB phases.
  
  
  RESULTS
  Among HBeAg (+) patients (29.3 %), HBV pre-core (PC) and basal core promoter (BCP) mutations were detected in 24.4 % and 31.3 %, respectively. Using baseline conventional ALT criteria, 97/153 (63.4 %) patients could be categorized into CHB phases 1 to 4, whereas 56/153 (36.6 %) were indeterminate. Using the modified ALT criteria, 43 (28.1 %) patients had phase changes of which 31/43 (72.1 %) were moved from phase 1 and indeterminate to phases 2 and 4, more active CHB phases. In 13/31 of these patients with liver biopsy, 6 (19.4 %) reported stage 2-4 fibrosis and 10 (32.3 %) reported grade 1-2 inflammation. Using modified ALT criteria to evaluate 48/153 patients with full data at baseline and the end of 1-year follow-up, we observed that 19/48 (39.6 %) changed their CHB phases; 5/48 (10.4 %) moved from phases 1 and 3 to phases 2 and 4; 2/48 (4.2 %) remained in the active phases; 10/48 (20.8 %) became indeterminate.
  
  
  CONCLUSIONS
  HBV PC and BCP mutations were detectable in 24.4 % and 31.3 % of HBeAg (+) AsAm patients, respectively. Compared with conventional ALT criteria, modified ALT criteria is more sensitive in identifying CHB patients in active phases.
authors: Department of Internal Medicine, University of Southern California, Los Angeles, CA, USA.
authors: Yu-Nan
authors: YN
authors: Hsu
authors: Calvin Q
authors: CQ
authors: Pan
authors: Ali
authors: A
authors: Abbasi
authors: Victor
authors: V
authors: Xia
authors: Raghav
authors: R
authors: Bansal
authors: Ke-Qin
authors: KQ
authors: Hu
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D001213:Asian; D005260:Female; D006515:Hepatitis B virus; D019694:Hepatitis B, Chronic / Q000097:blood / Q000175:diagnosis* / Q000208:ethnology / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019562:Viral Load
chemical_list: D000410:Alanine Transaminase