title: The prognosis and management of inactive HBV carriers.
abstract: Patients with chronic hepatitis B virus (HBV) infection lacking the serum hepatitis B e antigen (HBeAg) and with antibodies against HBeAg (anti-HBe), are the prevalent subgroup of HBV carriers worldwide. The prognosis of these patients is different from inactive carriers (ICs), who are characterized by persistently normal serum alanine aminotransferase (ALT) and low (<2000 IU/ml) serum HBV DNA levels, a serological profile that may also be intermittently observed in patients with HBeAg-negative chronic hepatitis. This is why a confirmed diagnosis of IC requires quarterly ALT and HBV DNA measurements for at least 1 year, while a single-point detection of combined HBsAg <1000 IU/ml and HBV DNA <2000 IU/ml has a robust predictive value for the diagnosis of IC. Characteristically, ICs have minimal or no histological lesions of the liver corresponding to liver stiffness values on Fibroscan of <5 kPa. Antiviral treatment is not indicated in ICs since the prognosis for the progression of liver disease is favourable if there are no cofactors of liver damage such as alcohol abuse, excess weight or co-infection with the hepatitis C virus or delta virus. Moreover, spontaneous HBsAg loss frequently occurs (1-1.9% per year) in these patients while the development of hepatocellular carcinoma (HCC) is rare, at least in Caucasian patients. However, an emerging issue reinforcing the need for clinical surveillance of ICs is the risk of HBV reactivation in patients who undergo immunosuppressive therapy without receiving appropriate antiviral prophylaxis. After diagnosis, management of ICs includes monitoring of ALT and HBV DNA every 12 months with periodic measurement of serum HBsAg levels to identify viral clearance.
authors.affiliation: 'A. M. and A. Migliavacca' Center for Liver Disease, Division of Gastroenterology and Hepatology Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università di Milano, Milano, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Invernizzi
authors.affiliation: Hepatology Unit, Ospedale San Giuseppe, Università degli Studi di Milano, Milano, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Viganò
authors.affiliation: 'A. M. and A. Migliavacca' Center for Liver Disease, Division of Gastroenterology and Hepatology Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università di Milano, Milano, Italy.
authors.forename: Glenda
authors.initials: G
authors.lastname: Grossi
authors.affiliation: 'A. M. and A. Migliavacca' Center for Liver Disease, Division of Gastroenterology and Hepatology Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università di Milano, Milano, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Lampertico
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000821:virology; D002353:Carrier State / Q000453:epidemiology / Q000821:virology*; D060085:Coinfection / Q000188:drug therapy; D004279:DNA, Viral / Q000097:blood; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006513:Hepatitis B e Antigens / Q000097:blood; D006515:Hepatitis B virus; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008113:Liver Neoplasms / Q000821:virology; D011379:Prognosis
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D006513:Hepatitis B e Antigens; D000410:Alanine Transaminase
keywords: HCC; antiviral treatment; hepatitis B virus; inactive carriers; natural history; prophylaxis