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Significant histological changes and satisfying antiviral efficacy in chronic hepatitis B virus infection patients with normal alanine aminotransferase. Antiviral therapy decision in chronic HBV patients with normal ALT - 19/07/20

Doi : 10.1016/j.clinre.2020.05.011 
Zhao Wu a , An-Lin Ma d , Qing Xie e , Xu-Qing Zhang f , Jun Cheng g , Da-Zhi Zhang h , Gui-Qiang Wang a, b, c, , Hong Zhao a, c,
a Department of Infectious Disease, Center for Liver Disease, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, China 
b The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, Zhejiang, China 
c Peking University International Hospital, Beijing, China 
d Department of Infectious Disease, China–Japan Friendship Hospital, Beijing, China 
e Department of Infectious Disease, Rui Jin Hospital Shanghai Jiao Tong, University School of Medicine, Shanghai, China 
f Department of Infectious Diseases, South West Hospital affiliated to Third, Military Medical University, Chongqin, China 
g Department of Infectious Diseases, Di Tan Hospital affiliated to Capital, Medical University, Beijing, China 
h Department of Infectious Diseases, Second Affiliated Hospital of Chongqing, Medical University, Chongqing, China 

Corresponding author⁎⁎Co-Corresponding author
Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Sunday 19 July 2020
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Highlights

Half of chronic HBV patients with normal ALT should start antiviral therapy.
Liver biopsy is the gold standard for antiviral therapy decision in such patients.
Noninvasive clinical markers were found to decrease the need of liver biopsy.
AST, anti-HBc and Fibroscan helped identify patients in need of antiviral therapy.
Patients with normal or elevated ALT had similar antiviral efficacy.

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Summary

Background and aims

A proportion of chronic hepatitis B virus (HBV) infection patients with normal alanine aminotransferase (ALT) should start antiviral therapy based on liver biopsy. We aim to evaluate the proportion of such patients, find noninvasive methods for identifying and then evaluate antiviral efficacy.

Methods

253 chronic HBV infection patients with normal ALT were analyzed at baseline and 57 patients with histological indication for antiviral therapy (Histology activity index ≥5 and/or Ishak fibrosis score ≥3) and 140 patients with elevated ALT received entecavir therapy and were followed-up to 78 weeks with a second liver biopsy in this multi-center study.

Results

127 (50.2%) of 253 patients with normal ALT fulfilled histological indication for antiviral therapy. Aspartate aminotransferase (P=0.049), anti-hepatitis B virus core antibody (P=0.001) and liver stiffness measurement (P=0.000) were independent variables for identifying histological indication for antiviral therapy. A noninvasive model (AAF) performed best among independent variables and other noninvasive models with area under the operating characteristic curve of 0.887. Antiviral efficacy showed that 38 (66.7%) of 57 patients had undetectable HBV DNA. 12 (41.4%) of 29 patients who were hepatitis B e antigen (HBeAg)-positive at baseline achieved HBeAg loss and 3 (10.3%) achieved HBeAg seroconversion. 25 (43.9%) of 57 patients achieved histological response. Moreover, 57 patients with normal ALT had a similar antiviral therapy efficacy with 140 patients with elevated ALT (P>0.1) except proportion of inflammation improvement and histological response (P=0.005, P=0.049).

Conclusions

Half of chronic HBV patients with normal ALT should start antiviral therapy based on liver biopsy. A noninvasive model could be used as a reliable tool for antiviral therapy decision. Patients with normal or elevated ALT had a similar antiviral efficacy.

Le texte complet de cet article est disponible en PDF.

Keywords : Hepatitis B virus, Histological indication for antiviral therapy, Noninvasive methods, Antiviral efficacy


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© 2020  The Authors. Publié par Elsevier Masson SAS. Tous droits réservés.
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