ADVANCED LIVER INJURY IN PATIENTS WITH CHRONIC HEPATITIS B AND VIRAL LOAD BELOW 2,000 IU/mL.
According to the guidelines, the viral load of 2,000 IU/mL is considered the level to differentiate between inactive carriers and HBeAg(-) chronic hepatitis B patients. Even so, liver damage may be present in patients with lower viral load levels, mainly related to regional variations. This study aims to verify the presence of liver injury in patients with viral load below 2,000 IU/mL.
Patients presenting HBsAg(+) for more than six months, Anti-HBe(+)/HBeAg(-), viral load below 2,000 IU/mL and serum ALT levels less than twice the upper limit of normality underwent liver biopsy. Clinical and laboratory characteristics were evaluated in relation to the degree of histologic alteration. Liver injury was considered advanced when F ≥ 2 and/or A ≥ 2 by the METAVIR classification.
11/27 (40.7%) patients had advanced liver injury, with a mean viral load of 701.0 (± 653.7) IU/mL versus 482.8 (± 580.0) IU/mL in patients with mild injury. The comparison between the mean values of the two groups did not find a statistical difference (p = 0.37). The average of serum aminotransferases was not able to differentiate light liver injury from advanced injury.
In this study, one evaluation of viral load did not exclude the presence of advanced liver damage. Pathologic assessment is an important tool to diagnose advanced liver damage and should be performed in patients with a low viral load to indicate early antiviral treatment.
Federal University of Sergipe, Department of Medicine, Hepatology Unit. Aracaju, SE, Brazil. E-mails: valteroberdan@ig.com.br; juli_passos@hotmail.com; eloy_franca@hotmail.com; terezahepato@gmail.com; avcfranca@hotmail.com.
Valter Oberdan Borges de
VO
Oliveira
Federal University of Sergipe, Department of Medicine, Hepatology Unit. Aracaju, SE, Brazil. E-mails: valteroberdan@ig.com.br; juli_passos@hotmail.com; eloy_franca@hotmail.com; terezahepato@gmail.com; avcfranca@hotmail.com.
Juliana Passos Rocha
JP
Oliveira
Federal University of Sergipe, Department of Medicine, Hepatology Unit. Aracaju, SE, Brazil. E-mails: valteroberdan@ig.com.br; juli_passos@hotmail.com; eloy_franca@hotmail.com; terezahepato@gmail.com; avcfranca@hotmail.com.
Eloy Vianey Carvalho de
EV
França
Federal University of Sergipe, Department of Pathology. Aracaju, SE, Brazil. E-mail: hugoleite.brito@gmail.com.
Hugo Leite de Farias
HL
Brito
Federal University of Sergipe, Department of Medicine, Hepatology Unit. Aracaju, SE, Brazil. E-mails: valteroberdan@ig.com.br; juli_passos@hotmail.com; eloy_franca@hotmail.com; terezahepato@gmail.com; avcfranca@hotmail.com.
Tereza Virgínia
TV
Nascimento
Federal University of Sergipe, Department of Medicine, Hepatology Unit. Aracaju, SE, Brazil. E-mails: valteroberdan@ig.com.br; juli_passos@hotmail.com; eloy_franca@hotmail.com; terezahepato@gmail.com; avcfranca@hotmail.com.
Alex
A
França
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