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Chen HM, Xia M, Zheng XF, Zheng JC. Long-term clinical outcomes of maintenance therapy with nucleos(t)ide analogues in chronic hepatitis B patients with low-level viremia: A systematic review and meta-analysis. Shijie Huaren Xiaohua Zazhi 2024; 32:686-694. [DOI: 10.11569/wcjd.v32.i9.686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 08/26/2024] [Accepted: 09/19/2024] [Indexed: 09/28/2024] Open
Abstract
BACKGROUND For chronic hepatitis B patients who develop low-level viremia (LLV) after treatment with first-line nucleos(t)ide analogues (NAs), there is still a lack of research on the long-term clinical outcomes of continuing NAs therapy.
AIM To evaluate the long-term clinical outcomes of continuing the original NAs therapy vs switching to a different NAs regimen in patients with chronic hepatitis B experiencing LLV after first-line NAs treatment through a systematic review and meta-analysis.
METHODS Relevant studies were selected through computer searches of PubMed, Embase, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), and Wanfang databases. R4.3.1 software was used for meta-analysis of the included studies.
RESULTS A total of 11 articles involving 3153 chronic hepatitis B patients with LLV were included. Among them, 7 articles conducted quantitative meta-analysis of HBV DNA seroconversion rate, indicating that the HBV DNA seroconversion rate in the group switching to a new NAs regimen after 24 wk [relative risk (RR) = 4.23, 95% confidence interval (CI): 2.47-7.24), P < 0.01] and 48 wk (RR = 2.90, 95%CI: 1.75-4.81, P < 0.01) of continued treatment was significantly higher than that of the group continuing the original NAs regimen. Six articles conducted quantitative meta-analysis of HBeAg seroconversion rate, showing that the HBeAg seroconversion rate of the group switching to a new NAs treatment regimen after 24 wk was higher than that of the group continuing the original regimen (RR = 2.31, 95%CI: 1.28-4.19, P < 0.01), but there was no significant difference between the two groups when switching occured at 48 wk (RR = 1.50, 95%CI: 0.88-2.54, P = 0.13). Qualitative systematic evaluation of the incidence of end-stage liver disease was conducted in 3 articles, showing that the LLV group continuing NAs treatment had a significantly higher incidence of long-term end-stage liver disease compared to the maintained virological response (MVR) group (P < 0.05).
CONCLUSION Switching to a new NAs regimen can improve the long-term HBV DNA and HBeAg seroconversion rates in chronic hepatitis B patients with LLV, but the incidence of end-stage liver disease in patients continuing NAs treatment is significantly higher than that of patients with MVR.
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Affiliation(s)
- He-Min Chen
- People's Hospital of Jiangshan, Jiangshan 324100, Zhejiang Province, China
| | - Ming Xia
- People's Hospital of Jiangshan, Jiangshan 324100, Zhejiang Province, China
| | - Xu-Feng Zheng
- People's Hospital of Jiangshan, Jiangshan 324100, Zhejiang Province, China
| | - Ji-Cai Zheng
- People's Hospital of Jiangshan, Jiangshan 324100, Zhejiang Province, China
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Tunçer G, Geyiktepe-Güçlü C, Bayramlar OF, Atasoy-Bozan B, Yücel Ç, Sürme S, Çopur B, Güçlü KG, Mustafayev K, İkizceli T, Uzuner EG, Yıldırım M, Şengöz G, Pehlivanoglu F. Predictors of Significant Histological Hepatic Abnormality in Treatment-Naive Patients Infected with HBeAg-Negative Chronic Hepatitis B. INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2024; 6:22-31. [PMID: 38633437 PMCID: PMC11019720 DOI: 10.36519/idcm.2024.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/14/2024] [Indexed: 04/19/2024]
Abstract
Objective This study aimed to determine the predictors for significant hepatic abnormality (SHA), a treatment indication, by assessing demographic, laboratory, and radiological results of chronic hepatitis B (CHB) patients who underwent liver biopsy. Materials and Methods In this retrospective study, individuals with untreated hepatitis B e-antigen (HBeAg)-negative CHB infection were enrolled. Multivariate analysis modeling was conducted with parameters identified as predictors for SHA in univariate analysis. Optimal threshold levels for variables to predict SHA in patients with chronic hepatitis B were determined based on receiver operating characteristic (ROC) curve analysis. Results A total of 566 patients with untreated chronic hepatitis B were included in the cohort; 61% (345/566) were male, and the median age was 41 years (interquartile range [IQR]=34-50). Notably, 36.9% (209/566) had SHA. In the multivariate analysis, utilizing different models, age, gender, HBV-DNA, LDL, ALT, and platelet count were identified as the most reliable predictors for SHA in CHB patients. For predicting SHA, the area under the ROC curve values of HBV-DNA, AST, and ALT were 0.704 (sensitivity=62.8%, specificity=76.2%; p<0.0001), 0.747 (sensitivity=51.9%, specificity=88.9%; p<0.0001), and 0.737 (sensitivity=68.6%, specificity=68.4%; p<0.0001), respectively. Conclusion In our study, age, male gender, ALT, AST, HBV-DNA, LDL cholesterol, platelet count, and FIB-4 score were independent predictors of SHA in HBeAg-negative chronic hepatitis B. The most sensitive parameters for SHA were LDL and ALT. The most specific parameters were age, AST, and APRI score. SHA may occur in patients with high HBV-DNA levels, even if ALT values are normal in HBeAg-negative patients.
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Affiliation(s)
- Gülşah Tunçer
- Department of Infectious Diseases and Clinical Microbiology, Haseki Training Research Hospital, İstanbul, Türkiye
| | - Ceyda Geyiktepe-Güçlü
- Department of Infectious Diseases and Clinical Microbiology, Haseki Training Research Hospital, İstanbul, Türkiye
| | | | - Burcu Atasoy-Bozan
- Department of Infectious Diseases and Clinical Microbiology, Haseki Training Research Hospital, İstanbul, Türkiye
| | - Çiğdem Yücel
- Department of Infectious Diseases and Clinical Microbiology, Haseki Training Research Hospital, İstanbul, Türkiye
| | - Serkan Sürme
- Department of Medical Microbiology, İstanbul University-Cerrahpaşa, İstanbul, Türkiye
| | - Betül Çopur
- Department of Infectious Diseases and Clinical Microbiology, Haseki Training Research Hospital, İstanbul, Türkiye
| | - Kadir Görkem Güçlü
- Department of Infectious Diseases and Clinical Microbiology, Haseki Training Research Hospital, İstanbul, Türkiye
| | - Khalis Mustafayev
- Department of Infectious Diseases, Infection Control and Employee Health, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Türkan İkizceli
- Department of Radiology, Haseki Training Research Hospital, İstanbul, Türkiye
| | - Esen Gül Uzuner
- Department of Medical Pathology, Haseki Training Research Hospital, İstanbul, Türkiye
| | - Mustafa Yıldırım
- Department of Infectious Diseases and Clinical Microbiology, Haseki Training Research Hospital, İstanbul, Türkiye
| | - Gönül Şengöz
- Department of Infectious Diseases and Clinical Microbiology, Haseki Training Research Hospital, İstanbul, Türkiye
| | - Filiz Pehlivanoglu
- Department of Infectious Diseases and Clinical Microbiology, Haseki Training Research Hospital, İstanbul, Türkiye
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Jiang C, Liu J, Li R, Chen K, Peng W, Fu L, Peng S. Clinicopathologic characteristics of liver inflammation and fibrosis in 310 patients with chronic hepatitis B. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2023; 48:698-706. [PMID: 37539572 PMCID: PMC10930400 DOI: 10.11817/j.issn.1672-7347.2023.220622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Indexed: 08/05/2023]
Abstract
OBJECTIVES Long-term hepatitis B virus (HBV) infection can cause recurrent inflammation in the liver, and then develop into liver fibrosis, cirrhosis, and liver cancer. The hepatic pathological change is one of the important criteria for guiding antiviral therapy in patients with chronic hepatitis B (CHB). Due to the limitations of liver biopsy, it is necessary to find valuable non-invasive indicators to evaluate the hepatic pathological changes in CHB patients and guide the antiviral therapy. This study aims to analyze the clinical characteristics of different pathological changes in CHB patients, and to explore the factors influnencing the degree of liver inflammation and fibrosis in CHB patients with normal alanine aminotransferase (ALT). METHODS This retrospective study was conducted on 310 CHB patients. Liver biopsy was performed in all these patients. The clinical data of the patients were collected. The liver biopsy pathological results were used as the gold standard to analyze the relationship between clinical indicators and liver pathological changes. Then CHB patients with normal ALT were screened, and the independent factors influencing the degree of liver inflammation and fibrosis were explored. RESULTS Among the 310 patients with CHB, there were 249 (80.3%) patients with significant liver inflammation [liver inflammation grade (G) ≥2] and 119 (38.4%) patients with significant liver fibrosis [liver fibrosis stage (S) ≥2]. The results of univariate analysis of total samples showed that the ALT, γ-glutamyl transferase, alkaline phosphatase, and HBV DNA were related to the significant liver pathological changes. Among the 132 CHB patients with normal ALT, the patients with liver pathology G/S≥2, G≥2, and S≥2 were 80.3% (106/132), 68.2% (90/132), and 43.2% (57/132), respectively. The results showed that the independent influencing factor of significant liver inflammation was HBV DNA>2 000 U/mL (OR=3.592, 95% CI 1.534 to 8.409), and the independent influencing factors of significant liver fibrosis were elevated alkaline phosphatase level (OR=1.022, 95% CI 1.002 to 1.043), decreased platelet count (OR=0.990, 95% CI 0.982 to 0.998), and positive in hepatitis B e antigen (HBeAg) (OR=14.845, 95% CI 4.898 to 44.995). According to the multivariate analysis, a diagnostic model for significant liver fibrosis in CHB patients with normal ALT was established, and the area under the receiver operating characteristic curve was 0.844 (95% CI 0.779 to 0.910). CONCLUSIONS The liver pathological changes should be evaluated in combination with different clinical indicators. A considerable number of CHB patients with normal ALT still have significant liver pathological changes, which need to be identified and treated with antiviral therapy in time. Among them, HBV DNA>2 000 U/mL suggests the significant liver inflammation, and the diagnostic model for significant liver fibrosis based on alkaline phosphatase, platelet count, and HBeAg can help to evaluate the degree of liver fibrosis.
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Affiliation(s)
- Chuan Jiang
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha 410008.
| | - Jinqing Liu
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha 410008
| | - Ronghua Li
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Keyu Chen
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha 410008
| | - Wenting Peng
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha 410008
| | - Lei Fu
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha 410008
| | - Shifang Peng
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha 410008.
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Huang X, Yan M, Deng Z, Yao L, Han D, Sun L. Natural history of decompensated cirrhosis with serum hepatitis B DNA < 2000 IU/mL: a retrospective study. BMC Gastroenterol 2022; 22:452. [PMID: 36352372 PMCID: PMC9647958 DOI: 10.1186/s12876-022-02541-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/17/2022] [Indexed: 11/11/2022] Open
Abstract
Background and aims Patients with low HBV DNA levels (< 2000 IU/mL), HBV DNA negative, and HBsAg-negative hepatitis B virus(HBV)infection can still progress to decompensated cirrhosis; however, clinical research data in such patients, especially treatment-naïve patients, are currently insufficient. This study assessed the natural history of aforementioned patients. Methods We retrospectively reviewed the data of 250 patients with HBV-associated decompensated cirrhosis(HBV DNA < 2000 IU/mL) who had not been treated with antiviral medication. Results The mean age of the 250 patients was 53.90 ± 11.73 years and 183 patients (73.2%) were male. HBV DNA, HBsAg, and HBeAg positivity was detected in 77 (30.8%), 200 (80%), and 137 (54.8%) patients, respectively. HBsAg (odds ratio [OR], 3.303; 95% confidence interval [CI], 1.338–8.152; P = 0.010) and HBeAg (OR, 0.200; 95% CI, 0.107–0.376; P < 0.001) positivity were independent factors for low HBV DNA levels. The incidence of hepatocellular carcinoma (HCC) (P < 0.001) and portal vein thrombosis (P = 0.001) was higher in the low HBV DNA levels group. Multivariate analysis showed that HBV DNA positivity (OR, 3.548; 95% CI, 1.463–8.604; P = 0.005), HBeAg positivity (OR, 0.080; 95% CI, 0.022–0.289; P < 0.001), and glutamyltransferase (GGT) (OR, 1.003; 95% CI, 1.000–1.006; P = 0.040) were independent factors for HCC. Age was not related to the occurrence of cirrhosis complications. Conclusion Patients with decompensated cirrhosis with HBV DNA < 2000 IU/mL still had severe liver damage and could develop severe cirrhosis complications. HCC risk was higher in low HBV DNA levels patients. HBsAg positivity and HBeAg negativity may be associated to the occurrence of low HBV DNA levels.
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Sheng Q, Wang N, Zhang C, Fan Y, Li Y, Han C, Wang Z, Wei S, Dou X, Ding Y. HBeAg-negative Patients with Chronic Hepatitis B Virus Infection and Normal Alanine Aminotransferase: Wait or Treat? J Clin Transl Hepatol 2022; 10:972-978. [PMID: 36304490 PMCID: PMC9547271 DOI: 10.14218/jcth.2021.00443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/25/2021] [Accepted: 02/27/2022] [Indexed: 12/04/2022] Open
Abstract
Alanine aminotransferase (ALT) is a common clinical indicator of liver inflammation. The current Chinese guidelines for the management of chronic hepatitis B (CHB) recommend antiviral treatment for patients with detectable hepatitis B virus (HBV) DNA and persistent ALT levels (ALTs) exceeding the upper limit of normal. However, it has been recently reported that patients with chronic HBV infection, especially HBeAg-negative patients with persistently normal ALTs, may have liver biopsy findings of significant inflammation and fibrosis. For HBeAg-negative patients with chronic HBV infection and normal ALTs, many controversial questions have been asked. To treat or not? When to initiate the treatment? Which drug is appropriate? In this review, we summarize the available data on the management of HBeAg-negative patients with chronic HBV infection and normal ALTs with the aim of improving the current clinical management.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Xiaoguang Dou
- Correspondence to: Xiaoguang Dou and Yang Ding, Department of Infectious Diseases, Shengjing Hospital of China Medical University, No. 39 HuaXiang Road, TieXi District,Shenyang, Liaoning 110022, China. ORCID: https://orcid.org/0000-0003-1856-7331 (XGD), https://orcid.org/0000-0002-7066-2865 (YD). Tel: +86-18940251121 (XGD), +86-13332434847 (YD), Fax: +86-24-25998744, E-mail: (XGD), (YD)
| | - Yang Ding
- Correspondence to: Xiaoguang Dou and Yang Ding, Department of Infectious Diseases, Shengjing Hospital of China Medical University, No. 39 HuaXiang Road, TieXi District,Shenyang, Liaoning 110022, China. ORCID: https://orcid.org/0000-0003-1856-7331 (XGD), https://orcid.org/0000-0002-7066-2865 (YD). Tel: +86-18940251121 (XGD), +86-13332434847 (YD), Fax: +86-24-25998744, E-mail: (XGD), (YD)
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Zhang Q, Cai DC, Hu P, Ren H. Low-level viremia in nucleoside analog-treated chronic hepatitis B patients. Chin Med J (Engl) 2021; 134:2810-2817. [PMID: 34759219 PMCID: PMC8668013 DOI: 10.1097/cm9.0000000000001793] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Indexed: 12/14/2022] Open
Abstract
ABSTRACT Low-level viremia (LLV) was defined as persistent or intermittent episodes of detectable hepatitis B virus (HBV) DNA (<2000 IU/mL, detection limit of 10 IU/mL) after 48 weeks of antiviral treatment. Effective antiviral therapies for chronic hepatitis B (CHB) patients, such as entecavir (ETV), tenofovir disoproxil fumarate (TDF), and tenofovir alafenamide (TAF), have been shown to inhibit the replication of HBV DNA and prevent liver-related complications. However, even with long-term antiviral therapy, there are still a number of patients with persistent or intermittent LLV. At present, the research on LLV to address whether adversely affect the clinical outcome is limited, and the follow-up treatment for these patients is open to question. At the same time, the mechanism of LLV is not clear. In this review, we summarize the incidence of LLV, the association between LLV and long-term outcomes, possible mechanisms, and management strategies in these patient populations.
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Affiliation(s)
- Qian Zhang
- Department of Infectious Diseases, Institute for Viral Hepatitis, The Key Laboratory of Molecular Biology for Infectious Diseases, Chinese Ministry of Education, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
- Department of Infectious Diseases, Guizhou Provincial People's Hospital, Guiyang, Guizhou 550001, China
| | - Da-Chuan Cai
- Department of Infectious Diseases, Institute for Viral Hepatitis, The Key Laboratory of Molecular Biology for Infectious Diseases, Chinese Ministry of Education, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Peng Hu
- Department of Infectious Diseases, Institute for Viral Hepatitis, The Key Laboratory of Molecular Biology for Infectious Diseases, Chinese Ministry of Education, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Hong Ren
- Department of Infectious Diseases, Institute for Viral Hepatitis, The Key Laboratory of Molecular Biology for Infectious Diseases, Chinese Ministry of Education, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
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Zhang X, Guan L, Tian H, Zeng Z, Chen J, Huang D, Sun J, Guo J, Cui H, Li Y. Risk Factors and Prevention of Viral Hepatitis-Related Hepatocellular Carcinoma. Front Oncol 2021; 11:686962. [PMID: 34568017 PMCID: PMC8458967 DOI: 10.3389/fonc.2021.686962] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 08/20/2021] [Indexed: 12/11/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is a common cancer in the world, and its incidence is increasing yearly. Hepatitis B virus (HBV) infection and hepatitis C virus (HCV) infection are important causes of HCC. Liver cirrhosis, age, sex, smoking and drinking, and metabolic risk factors will increase the risk of cancer in HBV/HCV patients. And viral load, APRI, FIB-4, and liver stiffness can all predict the risk of HCC in patients with viral infection. In addition, effective prevention strategies are essential in reducing the risk of HCC. The prevention of HCC involves mainly tertiary prevention strategies, while the primary prevention is based on standardized vaccine injections to prevent the occurrence of HBV/HCV. Eliminating the route of transmission and vaccination will lead to a decrease in the incidence of HCC. Secondary prevention involves effective antiviral treatment of HBV/HCV to prevent the disease from progressing to HCC, and tertiary prevention is actively treating HCC to prevent its recurrence.
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Affiliation(s)
- Xinhe Zhang
- Gastroenterology Department, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Lin Guan
- Gastroenterology Department, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Haoyu Tian
- The 3rd Clinical Department of China Medical University, Shenyang, China
| | - Zilu Zeng
- Gastroenterology Department, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jiayu Chen
- Gastroenterology Department, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Die Huang
- Gastroenterology Department, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Ji Sun
- Gastroenterology Department, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jiaqi Guo
- Gastroenterology Department, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Huipeng Cui
- Gastroenterology Department, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yiling Li
- Gastroenterology Department, The First Affiliated Hospital of China Medical University, Shenyang, China
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Yenilmez E, Cetinkaya RA. Are there optimal alanine aminotransferase and HBV DNA thresholds for discriminating HBeAg-positive chronic infection from chronic hepatitis? An evaluation of 215 young and male cases. Saudi Med J 2019; 40:131-139. [PMID: 30723857 PMCID: PMC6402459 DOI: 10.15537/smj.2019.2.23934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 01/10/2019] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To define the importance of biochemical and virological thresholds for the prediction of significant liver diseases. METHODS A total of 215 young and male HBeAg-positive cases followed up in a tertiary training and research hospital in Turkey between 2008 and 2017 enrolled in the retrospective diagnostic accuracy study. Results: Fibrosis scores varied between 0-4, F1 (n=81, 37.6%) and F2 (n=82, 38.1%) were the most frequent fibrosis stages. Of the patients, 58.6% (126/215) had a significant histopathological abnormality (SHA). The ratio of SHA was higher for ALT greater than 90 U/L (n=68/95; 71.6%) and HBV-DNA between 2,000,000-200,000,000 IU/mL (n=47/73; 64.4%). Thresholds for the higher odds ratio (OR) for SHA were greater than 90 U/L for alanine aminotransferase (ALT) and greater than 2,000,000 IU/mL for HBV-DNA. Based on receiver operating characteristic analysis, 90.5 U/L of ALT and 22,607,500 IU/mL of HBV-DNA were levels with the optimum sensitivity and specificity for the prediction of SHA. CONCLUSION Hepatitis B virus-DNA levels between 106 and 108 IU/mL and ALT levels of 2~3 x ULN might be considered to be good indicators for discriminating chronic hepatitis phase from chronic infection in hepatitis B e-antigen-positive chronic hepatitis. However, we think that the current biochemical, serological and molecular markers are inadequate for differentiating chronic hepatitis phase than chronic infection, and non-invasive test and/or liver histopathology should be carried out in selected cases.
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Affiliation(s)
- Ercan Yenilmez
- Department of Infectious Diseases and Clinical Microbiology, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey. E-mail.
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