Prognostic values of fluctuations in serum levels of alanine transaminase in inactive carrier state of HBV infection.
BACKGROUND
Current guidelines introduce periodic monitoring of serum alanine transaminase (ALT) as the first-line modality in follow-up patients, with a hepatitis B virus (HBV) inactive carrier state.


OBJECTIVE
This study aimed to determine the incidence rate and patterns of ALT fluctuations and prognostic values for the development of chronic HBV e antigen (HBeAg)-negative hepatitis B (CHB), HBV surface antigen (HBsAg) seroclearance, and liver-related complications.


METHODS
Treatment-naïve patients with a chronic HBV infection, HBeAg(-)/HBeAb(+), normal ALT levels, and HBV DNA < 2000 IU/mL, were followed-up every 6-12 months by assessing serum ALT levels. Serum HBV DNA was measured in cases of elevated ALT levels.


RESULTS
A total of 399 patients were followed-up for 8.9 years; ALT > upper limit of normal (ULN, i.e. 40 IU/L) was detected in 103 (25.8%) patients, with an annual incidence rate of 2.9%. ALT elevation was associated with; male gender, age, and higher serum ALT levels at study entry. Among the cases of ALT elevations, 16 (15.5%) patients had ALT levels > 2 × ULN. There were 38 (36.9%) patients who had ALT levels that remained > ULN over six months, and 21 (20.4%) patients experienced at least two episodes of ALT elevations. In 15 (14.6%) patients, elevated ALT levels were associated with increased HBV replication (i.e. HBV DNA > 2 000 IU/mL) and these were considered as CHB. However, elevation of ALT levels, even in the absence of HBV replication, increased the risk for the development of CHB up to 8-fold in prospective follow-ups. HBsAg seroclearance, cirrhosis, and hepatocellular carcinoma were detected in 43 (10.8%), 4 (1%), and 1 (0.25%) patients, respectively.


CONCLUSIONS
Fluctuations in serum ALT levels may change the prognosis of a HBV inactive carrier state.
Department of Gastroenterology and Hepatology, Tehran University of Medical Sciences, Tehran, IR Iran.
Hossein
H
Farzi
Department of Gastroenterology and Hepatology, Tehran University of Medical Sciences, Tehran, IR Iran.
Nasser
N
Ebrahimi Daryani
Middle East Liver Diseases Center (MELD), Tehran, IR Iran.
Leila
L
Mehrnoush
Middle East Liver Diseases Center (MELD), Tehran, IR Iran.
Shima
S
Salimi
Middle East Liver Diseases Center (MELD), Tehran, IR Iran.
Seyed Moayed
SM
Alavian
Alanine Transaminase; Hepatitis B Virus; Hepatitis B e Antigen; Hepatitis B, Chronic