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Clinical Presentation and Disease Phases of Chronic Hepatitis B Using Conventional Versus Modified ALT Criteria in Asian Americans

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Abstract

Background and Aim

The modified normal alanine aminotransferase (ALT) value (i.e., males <30 and females <19 IU/L) is a better criteria associated with histological activity in chronic hepatitis B (CHB). This study was aimed to assess if the modified ALT criteria could be better associated with disease phases in a cohort of Asian Americans (AsAm) with CHB.

Methods

This two-center retrospective study evaluated 198 non-treated AsAm with CHB and a mean follow-up of 21 months. Both conventional and modified ALT criteria were used to determine the differences and clinical value using modified ALT criteria in classifying CHB phases.

Results

Among HBeAg (+) patients (29.3 %), HBV pre-core (PC) and basal core promoter (BCP) mutations were detected in 24.4 % and 31.3 %, respectively. Using baseline conventional ALT criteria, 97/153 (63.4 %) patients could be categorized into CHB phases 1 to 4, whereas 56/153 (36.6 %) were indeterminate. Using the modified ALT criteria, 43 (28.1 %) patients had phase changes of which 31/43 (72.1 %) were moved from phase 1 and indeterminate to phases 2 and 4, more active CHB phases. In 13/31 of these patients with liver biopsy, 6 (19.4 %) reported stage 2–4 fibrosis and 10 (32.3 %) reported grade 1–2 inflammation. Using modified ALT criteria to evaluate 48/153 patients with full data at baseline and the end of 1-year follow-up, we observed that 19/48 (39.6 %) changed their CHB phases; 5/48 (10.4 %) moved from phases 1 and 3 to phases 2 and 4; 2/48 (4.2 %) remained in the active phases; 10/48 (20.8 %) became indeterminate.

Conclusions

HBV PC and BCP mutations were detectable in 24.4 % and 31.3 % of HBeAg (+) AsAm patients, respectively. Compared with conventional ALT criteria, modified ALT criteria is more sensitive in identifying CHB patients in active phases.

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Conflict of interest

Dr. Ke-Qin Hu has received research or educational grants from Gilead, Bristol Myers Squibb, Genentech, and Merck. He also serves as speaker bureau for Gilead, Bristol Myers Squibb, Genentech, and Merck. Dr. Calvin Q. Pan has received research grants from Gilead, Bristol Myers Squibb, Novartis, and Roche. He also serves as a consultant, advisor and speakers bureau for Gilead and Bristol Myers Squibb.

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Authors and Affiliations

  1. Department of Internal Medicine, University of Southern California, Los Angeles, CA, USA

    Yu-Nan Hsu

  2. Division of Gastroenterology, Mount Sinai School of Medicine at Elmhurst Hospital, New York, NY, USA

    Calvin Q. Pan & Raghav Bansal

  3. Division of Gastroenterology and Hepatology, University of California, Irvine Medical Center, 101 The City Drive, Building 56, Rt. 81, Rm. 231, Orange, CA, 92868, USA

    Ali Abbasi & Ke-Qin Hu

  4. Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Victor Xia

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  1. Yu-Nan Hsu
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  2. Calvin Q. Pan
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  3. Ali Abbasi
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  4. Victor Xia
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  5. Raghav Bansal
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Correspondence to Ke-Qin Hu.

Additional information

Yu-Nan Hsu and Calvin Q. Pan are co-first authors.

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Hsu, YN., Pan, C.Q., Abbasi, A. et al. Clinical Presentation and Disease Phases of Chronic Hepatitis B Using Conventional Versus Modified ALT Criteria in Asian Americans. Dig Dis Sci 59, 865–871 (2014). https://doi.org/10.1007/s10620-014-3054-1

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  • DOI: https://doi.org/10.1007/s10620-014-3054-1

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