title: Early termination of immune tolerance state of hepatitis B virus infection explains liver damage.
abstract: OBJECTIVE
  To assess an early termination of immune tolerance state of chronic hepatitis B virus infection in Bangladesh and its clinical significance.
  
  
  METHODS
  From a series of 167 treatment-naive chronic hepatitis B patients aged between 12 to 20 years (mean ± SD; 17.5 ± 2.8 years), percutaneous liver biopsies of 89 patients who were all hepatitis B e antigen negative at presentation were done. Of them, 81 were included in the study. They had persistently normal or raised serum alanine aminotransferase (ALT) values. A precore mutation (PCM) study was accomplished in 8 patients who were randomly selected.
  
  
  RESULTS
  Forty-four (53.7%) patients had significant necroinflammation (HAI-NI > 7), while significant fibrosis (HAI-F ≥ 3) was seen in 15 (18.5%) patients. Serum ALT (cut off 42 U/L) was raised in 29 (35.8%) patients, while low HBV DNA load (< 10(5) copies/mL) was observed in 57 (70.4%) patients. PCM was negative in all 8 patients.
  
  
  CONCLUSIONS
  This study indicates that the current concept of age-related immune tolerance state of HBV infection deserves further analyses in different population groups.
authors.affiliation: Mamun-Al-Mahtab, Salimur Rahman, Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka 1000, Bangladesh.
authors.lastname: Mamun-Al-Mahtab
authors.affiliation: Mamun-Al-Mahtab, Salimur Rahman, Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka 1000, Bangladesh.
authors.forename: Sheikh Mohammad Fazle
authors.initials: SM
authors.lastname: Akbar
authors.affiliation: Mamun-Al-Mahtab, Salimur Rahman, Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka 1000, Bangladesh.
authors.forename: Helal
authors.initials: H
authors.lastname: Uddin
authors.affiliation: Mamun-Al-Mahtab, Salimur Rahman, Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka 1000, Bangladesh.
authors.forename: Sakirul Islam
authors.initials: SI
authors.lastname: Khan
authors.affiliation: Mamun-Al-Mahtab, Salimur Rahman, Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka 1000, Bangladesh.
authors.forename: Salimur
authors.initials: S
authors.lastname: Rahman
keywords: Chronic hepatitis B; Early termination; Immune tolerance