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Background: More than 350 million people are chronic carriers of hepatitis B virus (HBV) and because of the high HBV-related morbidity and mortality, the global disease burden of HBV is substantial. In patients with HBeAg–negative chronic hepatitis B (CHB) with serumalanine aminotransferase (ALT) levels, 1-2 × upper limit of normal (ULN) and HBV DNA load of 10000 to 1 copies/mL, liver biopsy should be considered and treatment may be initiated if liver biopsy shows moderate/severe necro-inflammation or significant fibrosis.A dynamic balance between viral replication and host immune response is pivotal for the pathogenesis of liver disease in HBV infection.Due to immune response variability, there is thought to be a considerable difference in the histopathologic status of liver biopsy samplespresent in various populations. Objectives: Liver histopathology in asymptomatic patients with greater than 10000 DNA copies/mL despite negative Hbe Ag was studiedn to determine, the number of people that will benefit from a liver biopsy, and variables that will significantly be affected by viral loadchanges. Patients and Methods: Eighty-two symptomless hepatitis B patients, identified during screening tests, were entered into the study. All candidates were HBS Ag Positive, Hbe Ag negative, Hbe Ab positive, HDV Ab, HIV Ab 1, 2, and HCV Ab negative. In all cases HBV DNA virus load was greater than 10000 copies/mL (2000 U/mL). Liver biopsy was done after obtaining a written consent. Liver histopathology was reported based on the histological activity index (HAI). Results: Both HBV DNA load and serum ALT levels significantly correlated with the grade score. Both stage and grade significantly correlated with age. Stage score of liver specimens was significantly lower in women than men. Logistic regression analysis indicated that the baseline ALT and HBV DNA levels and age were independent predictors of the HAI score. Conclusions: In 10% of the patients, liver biopsy changed the treatment plan and treatment was started despite ALT levels being less than twice the normal level.

Females Have a Lower Liver Histopathological Score in HBeAg-Negative Chronic Hepatitis B Than Males