Digestive Diseases and Sciences

, Volume 59, Issue 4, pp 865–871 | Cite as

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

  • Yu-Nan Hsu
  • Calvin Q. Pan
  • Ali Abbasi
  • Victor Xia
  • Raghav Bansal
  • Ke-Qin Hu
Original Article


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.


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.


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.


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.


Asian Americans Hepatitis B virus (HBV) Chronic hepatitis B (CHB) Hepatitis Be antigen (HBeAg) Disease phase ALT criteria Natural history 


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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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Yu-Nan Hsu
    • 1
  • Calvin Q. Pan
    • 2
  • Ali Abbasi
    • 3
  • Victor Xia
    • 4
  • Raghav Bansal
    • 2
  • Ke-Qin Hu
    • 3
  1. 1.Department of Internal MedicineUniversity of Southern CaliforniaLos AngelesUSA
  2. 2.Division of GastroenterologyMount Sinai School of Medicine at Elmhurst HospitalNew YorkUSA
  3. 3.Division of Gastroenterology and HepatologyUniversity of California, Irvine Medical CenterOrangeUSA
  4. 4.Department of AnesthesiologyDavid Geffen School of Medicine at UCLALos AngelesUSA

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