title: Impact of liver biopsy on the decision to treat patients with chronic hepatitis B genotype D virus infection.
abstract: OBJECTIVE
  Patients with chronic hepatitis B virus (HBV) may exhibit significant liver pathology despite alanine aminotransferase (ALT) and HBV DNA levels below the cutoff values advised by treatment guidelines. We evaluated candidacy for HBV therapy when baseline histopathological changes are taken into consideration.
  
  
  METHODS
  Clinical, biochemical, serological, virological, and histopathological (METAVIR score) data of 117 patients with HBeAg-negative chronic HBV genotype D were collected and analyzed.
  
  
  RESULTS
  Significant pathology (≥F2 and/or ≥A2) and fibrosis (≥F2 ± ≥A2) were found in 73 (62.4%) and 59 (50.4%) patients, respectively. Based on HBV DNA (>2,000 IU/ml) and ALT levels >2 × 40 U/l (the standard cutoff value), only 31 (26.5%) patients were candidates for therapy. This increased to 58 (49.6%) patients when the new ALT cutoff values (30 U/l for males, and 19 U/l for females) were applied. Relying on either ≥F2 and/or A ≥2 or ≥F2 ± ≥A2 increases the treatment candidacy to 73 (62.4%) and 59 (50.4%) patients, respectively. Also, when compared with standard ALT cutoff values, applying both new ALT cutoff values with either significant pathology or fibrosis increases treatment candidacy to 28 (23.9%) and 42 (35.9%) patients, respectively.
  
  
  CONCLUSIONS
  Liver pathology is more reliable than ALT and HBV DNA in the decision to treat patients with HBeAg-negative chronic HBV genotype D.
authors.affiliation: Department of Infection and Immunity, The Research Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
authors.forename: Ahmed Ali
authors.initials: AA
authors.lastname: Al-Qahtani
authors.forename: Hamad Ibrahim
authors.initials: HI
authors.lastname: Al-Ashgar
authors.forename: Hadeel
authors.initials: H
authors.lastname: Al Mana
authors.forename: Mohammed Noreen
authors.initials: MN
authors.lastname: Al-Ahdal
authors.forename: Ali
authors.initials: A
authors.lastname: Soliman Ali
authors.forename: Ahmed Farouk
authors.initials: AF
authors.lastname: Hasanain
authors.forename: Ahmed
authors.initials: A
authors.lastname: Helmy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use*; D001706:Biopsy; D005260:Female; D005838:Genotype; D006513:Hepatitis B e Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000473:pathology* / Q000821:virology; D006801:Humans; D008099:Liver / Q000473:pathology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D019562:Viral Load; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D006513:Hepatitis B e Antigens; D000410:Alanine Transaminase