Relationship between level of hepatitis B virus DNA and liver disease: a population-based study of hepatitis B e antigen-negative persons with hepatitis B.

Abstract

BACKGROUND & AIMS:

There is little information on the proportion of persons with chronic hepatitis B virus (HBV) infection with active hepatitis. We aimed to determine the proportion of persons with hepatitis B e antigen-negative chronic HBV infection who develop immune-active HBV infection over time and the relationship between demographic and viral factors on severity of disease on liver biopsy.

METHODS:

We performed a longitudinal population-based cohort study of 754 Alaska Native patients with chronic HBV infection. Levels of alanine aminotransferase (ALT) were measured every 6 months, and levels of HBV DNA were measured at study entry and whenever ALT levels exceeded the upper limit of normal (ULN). Immune-active chronic HBV infection was defined as levels of ALT ≥ 30 U/L in men and >20 U/L in women and levels of HBV DNA >2000 IU/mL at 1 or more time points from 2001-2008. Liver biopsies were scored by using the modified histology activity index score of Knodell and the Ishak fibrosis score.

RESULTS:

Of the study participants, 186 (25%) met the criteria for immune-active HBV, 56% of these initially and 44% later during follow up. Of the 38 patients with liver biopsy results, only 1 of 16 with ALT levels consistently below twice the ULN and 1 of 19 with HBV DNA between 2000 and 20,000 IU/mL, vs 12 of 22 (55%) with ALT > twice ULN (P = .002) and 11 of 18 (61%) with 1 or more measurements of HBV DNA >20,000 IU/mL (P < .001), had moderate or severe hepatitis or fibrosis.

CONCLUSIONS:

In a cohort of Alaska Natives with chronic HBV infection, 25% met criteria for immune-active HBV. There is a low probability of advanced fibrosis if levels of HBV DNA never exceed 20,000 IU/mL.

• Authors: Brian J McMahon, Lisa Bulkow, Brenna Simons, Yuhong Zhang, Susan Negus, Chriss Homan, Philip Spradling, Eyasu Teshale, Daryl Lau, Mary Snowball, Stephen E Livingston
• Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (Clin Gastroenterol Hepatol) Vol. 12 Issue 4 Pg. 701-6.e1-3 (Apr 2014) ISSN: 1542-7714 [Electronic] United States
• PMID: 24035774 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 AGA Institute. Published by Elsevier Inc. All rights reserved.

Chemical References

• DNA, Viral
• Hepatitis B Antigens
• Alanine Transaminase

Topics

• Adult
• Alanine Transaminase (blood)
• Alaska
• Biopsy
• Cohort Studies
• DNA, Viral (blood)
• Female
• Hepatitis B Antigens (blood)
• Hepatitis B virus (isolation & purification)
• Hepatitis B, Chronic (pathology, virology)
• Histocytochemistry
• Humans
• Liver Cirrhosis (pathology)
• Longitudinal Studies
• Male
• Middle Aged
• Severity of Illness Index
• Viral Load