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Elevated HBV DNA increased risk for advanced fibrosis
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Patients with chronic hepatitis B virus infection may have a lower risk for advanced fibrosis if they have low levels of HBV DNA, according to study data.
Researchers conducted a cohort study of 754 patients with chronic hepatitis B virus infection (HBV) who lived in Alaska. Results showed participants who had measurements of HBV DNA greater than 20,000 IU/mL had moderate or severe hepatitis or fibrosis.
In the cohort, 186 patients were positive for immune-active HBV, 56% initially and the remainder during follow up. Alanine aminotransferase (ALT) levels were measured every 6 months, and HBV DNA levels were measured at baseline and whenever ALT levels exceeded the upper limit of normal (ULN) defined as ≥30 U/L in men and >20 U/L in women. ULN levels and HBV DNA >2,000 IU/mL at one or more points from 2001 to 2008, determined immune-active chronic HBV infection among patients.
Thirty-eight patients underwent liver biopsy, and one of 16 of those patients with ALT levels consistently below twice the ULN, and one of 19 patients with HBV DNA between 2,000 IU/mL and 20,000 IU/mL, had moderate or severe hepatitis or fibrosis. By comparison, 12 of 22 patients with ALT greater than twice the ULN (P=.002), and 11 of 18 patients with at least one measurement of HBV DNA >20,000 IU/mL (P<.001), displayed disease.
“Approximately 90% of patients whose HBV DNA levels never reached 20,000 IU/mL had only mild disease on biopsy,” researchers said. “The practice guidelines written by the three major international liver societies all recommend liver biopsy in patients with elevated ALT and HBV DNA levels between 2,000 and 20,000 IU/mL. If only a minority of these patients meet the histologic criteria for treatment, exposure to possible lifelong antiviral therapy may not be justifiable because of the high cost and attendant risk for drug resistance.”
Disclosure: Researcher Brenna Simons, PhD, reports receiving meeting support from Gilead.