ALT Course, Serum HBV DNA and Liver Stiffness Measurement for Therapeutic Decision in HBeAg-Negative Chronic Hepatitis B

2016 Hepatology Research In press;

AIM: To evaluate the utility of the combination of alanine aminotransferase (ALT) course, HBV DNA level and liver stiffness measurement (LSM) for determining significant liver disease in HBeAg-negative patients. METHODS: 399 consecutive HBeAg-negative patients with HBV DNA >2,000 IU/ml and documented serial measurements of ALT were enrolled to undergo LSM followed by liver biopsy. RESULTS: Using ALT /=200,000 IU/ml, significant pathological lesions defined as the presence of moderate to severe necroinflammation and/or significant fibrosis by METAVIR scoring was present in 40%, 45%, and 71% of PIEALT group and 15%, 31%, and 36% of PNALT group respectively. In PNALT patients with HBV DNA /=20,000 IU/ml, the need for liver biopsy could be reduced by 53% with a false positive of 14% when LSM >/=7 kPa is used as a predictor of significant pathological lesions. CONCLUSION: The combination of serial ALT, viral load and LSM appears to be a promising noninvasive tool, and thus a management algorithm for HBeAg-negative patients comprising of these noninvasive measures is proposed here with liver biopsy being pursued in selected cases.

Pubmed : 26946348