%0 Journal Article
%T The Role of Liver Fibrosis Assessment in the Management of Patients with Chronic Hepatitis B Infection: Lessons Learned from a Single Centre Experience
%A Raza Malik
%A Patrick Kennedy
%A Deepak Suri
%A Ashley Brown
%A Rob Goldin
%A Janice Main
%A Howard Thomas
%A Mark Thursz
%J Hepatitis Research and Treatment
%D 2011
%I Hindawi Publishing Corporation
%R 10.1155/2011/524027
%X Background & Aims. Assess the clinical utility of the Prati criteria and normal ALT (<40£¿IU/L) in a cohort of patients with chronic hepatitis B infection (CHB). Methods. Serology, radiology, and histology were obtained in 140 patients with CHB. Results. HBeAg+ group: 7 patients (7/56£¿12% HBeAg+ group) misclassified as ¡°immunotolerant¡±, with HBV DNA > 6 log copies/ml and normal ALT, who in fact had moderate/severe fibrosis on liver biopsy. HBeAg£¿ group: 10 patients with normal ALT and moderate/severe fibrosis on liver biopsy; 4 of these patients had >3 log copies/ml HBV DNA levels and 6 patients misclassified as ¡°inactive carriers¡± with negative HBV DNA levels normal ALT and moderate/severe fibrosis (6/84£¿7% HBeAg£¿ group). Two male HBeAg+ and three male HBeAg- patients with ALT between 20 and 30 IU/L and moderate/severe fibrosis on liver biopsy would have been further mischaracterised using the Prati criteria for normal ALT. Age and ethnic group were more important predictors of moderate/severe fibrosis in multivariate analysis. Conclusion. HBeAg status, age, ethnic origin with longitudinal assessment of LFTs and viral load should be studied in patients with ¡°normal ALT¡± at the upper end of normal range (ALT 20¨C40 IU/L) to appropriately classify patients and identify patients for liver fibrosis assessment to inform treatment decisions. 1. Introduction An estimated 400 million people worldwide have chronic hepatitis B virus infection, of whom 1 million people will die each year from its complications [1, 2]. In the United Kingdom, it is estimated that over 180,000 people are infected, with the numbers increasing rapidly (http://www.hepb.org.uk/). In general, patients with chronic hepatitis B infection have historically been stratified into 4 classic categories according to the natural history of the infection [2, 3].(1)Immune-tolerant phase: HBeAg positive with high levels of viral replication (HBV DNA levels: >6 log), normal ALT, without necroinflammation in the liver and a low risk of progression to cirrhosis. (2)Immune-active phase: HBeAg positive with high levels of viral replication (HBV DNA levels: >6 log), increased ALT, necroinflammation in the liver with a high risk of progression to cirrhosis.(3)Inactive HBV carrier state: these patients have undergone seroconversion to anti-HBe status. It is characterised by very low/undetectable HBV DNA levels, normal ALT, without necroinflammation on liver histology and low risk of progression to cirrhosis. (4)HBeAg-negative chronic hepatitis B infection (precore/basal core mutant disease) the development of
%U http://www.hindawi.com/journals/heprt/2011/524027/