A Misleading Parameter in the Diagnosis of Chronic Hepatitis B: Persistently Normal Transaminases

Abstract

Objectives: Most of the patients with hepatitis B e (HBe)-negative hepatitis B have persistently normal transaminases (PNALT) levels. Patients, who have higher fibrosis and necroinflammatory activity scores, are at high risk for hepatocellular carcinoma and cirrhosis. Therefore, it is important to distinguish between active and inactive hepatitis in this group. Materials and Methods: Sixty-six treatment-naive, non-cirrotic, HBe antigen (HBeAg)-negative and a PNALT and a level of a hepatitis B virus (HBV) DNA level of >= 2000 IU/mL were included in this study. lshak's scoring system was used for histopathological evaluation. Chronic hepatitis was defined as a fibrosis score of higher than/equal to 2 and/or a histological activity index score of higher than 4. Results: The percentage of patients diagnosed with advanced fibrosis score and high necroinflammatory activity was 65% and 48%, respectively. Accordingly, 76% of patients were considered to have chronic hepatitis. Level of the HBV DNA was the most significant value for predicting chronic hepatitis. 94.1% of patients with a HBV DNA value over 20000 IU/mL had chronic hepatitis (p<0.001). Conclusion: As a result of this study, it has been found that the prevalence of chronic hepatitis in our country was high in HBeAg-negative patients with PNALT and a HBV DNA level higher than 2000 IU/mL. We recommend starting treatment in patients with a HBV DNA level higher than 20000 IU/rnL without considering any other criteria. Close monitoring or biopsy is recommended in patients with HBV DNA values between 2000 and 20000 IU/mL.