Viral and host factors related with histopathologyc activity in patients with chronic hepatitis B and moderate or intermittently elevated alanine aminotransferase levels

• Published in: Revista española de enfermedades digestivas Vol. 102; no. 9; pp. 519 - 525
• Main Authors: Molina Pérez, E., Castroagudín, J. F., Aguilera Guirao, A., Otero Antón, E., Tomé Martínez de Rituerto, S., Mera Calviño, J., Rodríguez Calviño, J. J., Domínguez Muñoz, J. E.
• Format: Journal Article
• Language: English
• Published: Sociedad Española de Patología Digestiva 01.09.2010
• Subjects: Gastroenterology & Hepatology; Geriatrics & Gerontology; Infectious Diseases; Oncology; Pathology; Pharmacology & Pharmacy; Radiology, Nuclear Medicine & Medical Imaging; Surgery; Liver biopsy; Lesión histológica; Genotipo; Biopsia hepática; Genotype; Histological lesion; DNA-HBV; ADN-VHB; Alanina aminotransferasa; Chronic hepatitis B; HBV infection; Hepatitis crónica B; Infección por VHB; Alanine aminotransferase
• ISSN: 1130-0108
• DOI: 10.4321/S1130-01082010000900002

Objective: viral and host factors are related with progression of pathological lesion in chronic hepatitis B. We analyzed these factors in patients with moderate or intermittently elevated ALT levels, and its threshold that determinate significant histological activity. Patients and methods: retrospective analyses of viral and host parameters in 89 consecutive chronic hepatitis B patients biopsied because of moderate or intermittently elevated ALT levels [1-2 x ULN (ULN = 39 IU/mL)] and/or DNA-HBV > 2 x 10³ IU/mL in AntiHBe+ patients. It was analyzed age, gender, ALT levels, HBeAg, viral load and genotype. It was considered advanced histological lesion a Knodell Score (KS) > 7 and histological lesion indicating treatment, lobular inflammation ≥ 2 or fibrosis ≥ 2 according to Scheuer Classification. Results: KS > 7 and histological lesion indicating treatment was found in 47.8 and 60.7% respectively. It was observed relationship between age, male gender, ALT levels and viral load with histological damage (p < 0.05). Frequency of advanced lesion indicating treatment was upper in patients with ALT levels > ULN (69.1 vs. 47.1%, p = 0.04). There were not significant upper frequencies of advanced lesion when a cut-off of 40 years or DNA-HBV > 2 x 10³ IU/mL viral load or serological status HBeAg was considerate. Histological activity was lesser in genotype D patients than those infected with others genotypes (p < 0.05). Conclusion: upper frequency of advanced histological lesion in chronic hepatitis B patients with moderate or intermittently elevated ALT levels make recommended liver biopsy, independent of viral load and serological status HBeAg. Other factors like age, gender or genotype can help to indicate biopsy in individual cases.