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Follow-up and indications for liver biopsy in HBeAg-negative chronic hepatitis B virus infection with persistently normal ALT: a systematic review.
MedLine Citation:
PMID:  22450396     Owner:  NLM     Status:  Publisher    
BACKGROUND/OBJECTIVE: The adequacy of monitoring HBeAg-negative patients based on ALT activity is controversial and current guidelines favour liver biopsy in HBeAg-negative cases with normal ALT and HBV DNA >2,000 IU/mL. We systematically reviewed all the available histological data on HBeAg-negative patients with persistently normal ALT (PNALT) to determine the prevalence of significant liver disease and its associating factors. METHODS: Literature search to identify studies with adult HBeAg-negative patients who had PNALT as defined by the authors, a minimum follow-up of one year and histological data. Traditional cutoff values of normal ALT were used in all studies. The definitions of PNALT were considered as acceptable or good if there were ⩾3 ALT determinations at unspecified intervals during 6-12 month or predefined intervals during ⩾12 month periods, respectively. RESULTS: Six studies including 335 patients met our inclusion criteria. Of these, four studies with 246 patients had good or acceptable definitions of PNALT. In the latter four studies, more than minimal (usually mild) necro-inflammatory activity was observed in 10% and more than mild fibrosis in 8% of all patients (moderate fibrosis: 7%, severe fibrosis: 1%, cirrhosis: 0%), and in 3% and 5% of patients with HBV DNA ⩽20,000 IU/mL, respectively. CONCLUSIONS: Histologically significant liver disease is rare in HBeAg-negative patients with PNALT based on stringent criteria and serum HBV DNA ⩽20,000 IU/mL. Such cases can be considered as true inactive HBV carriers, who require neither liver biopsy nor immediate therapy but continued follow-up.
George V Papatheodoridis; Spilios Manolakopoulos; Yun-Fan Liaw; Anna Lok
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-3-23
Journal Detail:
Title:  Journal of hepatology     Volume:  -     ISSN:  0168-8278     ISO Abbreviation:  -     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-3-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8503886     Medline TA:  J Hepatol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012. Published by Elsevier B.V.
2[nd] Department of Internal Medicine, Athens University Medical School, "Hippokration" General Hospital of Athens, Greece;
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