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AbstractBackground and aims: HBV infection is a significant public health issue all over the world. Egypt shows marked variations of HBV prevalence by age, gender, and geographical distribution. Treatment guidelines for CHB are based on serum ALT, together with HBV viral load and liver inflammation or fibrosis. Our study aimed to compare histological findings between CHB patients with ALT levels >ULN and patients with normal levels.Methods: Twenty-nine CHB adult Egyptian patients were included in our cross-sectional study. Liver biopsy was performed for all patients to detect fibrosis stage and inflammation grade using the METAVIR score, which was used to divide patients into two groups: patients with mild to moderate fibrosis (F0-1-2) and patients with advanced fibrosis (F3-4). Patients were also categorized into patients with ALT normal ALT; and Patients with ALT values > ULN.Results: We found that moderate to severe inflammation was detected in 56.7% of cases with normal ALT compared to 28% of cases with raised ALT (P = 0.015). Advanced fibrosis was detected in 10.44% of cases with normal ALT and 20% of cases with raised ALT without a statistically significant difference between both groups.Conclusions: Liver injury is present in a considerable proportion of patients with normal and those with mild ALT rise, so, these cases need careful evaluation in order not to miss a treatment indication.

Histological Differences in Naiive Chronic Hepatitis B Patients with Normal and Elevated ALT