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Systematic review with meta‐analysis: the proportion of chronic hepatitis B patients with normal alanine transaminase ≤40 IU/L and significant hepatic fibrosis
Author(s) -
Chao D. T.,
Lim J. K.,
Ayoub W. S.,
Nguyen L. H.,
Nguyen M. H.
Publication year - 2014
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.12590
Subject(s) - medicine , alanine transaminase , hbeag , gastroenterology , hepatitis b virus , aspartate transaminase , cirrhosis , hepatitis b , hepatocellular carcinoma , fibrosis , elevated transaminases , hbsag , immunology , virus , alkaline phosphatase , biochemistry , chemistry , enzyme
Summary Background Chronic hepatitis B ( CHB ) may lead to cirrhosis, hepatocellular carcinoma and premature death. Elevated alanine transaminase ( ALT ) levels ≥ the upper limit of normal ( ULN ) are a major determinant for initiating anti‐viral therapy; however, ALT levels alone may not be predictive of hepatic fibrosis. Aim To determine the proportion of CHB patients with ALT ≤40 IU/L and liver fibrosis stage ≥2. Secondary goals include subgroup analysis by hepatitis B e antigen ( HB eAg) status, high hepatitis B virus ( HBV ) DNA levels, Asian ethnicity, lower ULN of ≤30 IU/L (males) and 19 IU/L (females), and advanced age. Methods Studies identified in EMBASE and MEDLINE (1/1990–6/2012) using the search criteria: “Hepatitis B”[Mesh] OR “Hepatitis B virus”[Mesh] OR “Hepatitis B, Chronic”[Mesh])) AND “Alanine Transaminase”[Mesh]) and abstracts containing the term ‘hepatitis’ from recent major U.S. gastroenterology and liver society meetings were considered. Results Among nine studies ( N = 830 patients), a significant proportion (20.7%; 95% CI: 16.2–26.0%) of CHB patients with ALT levels ≤40 IU/L had significant fibrosis irrespective of HB eAg status, high HBV DNA levels, ethnicity or age, although this proportion may be higher in patients older than 30–40 years old. The corresponding proportion was 27.8% even when the newer ULN of 30 IU/L (males) and 19 IU/L (females) was applied. Conclusions Approximately one fifth of CHB patients with ALT ≤40 IU/L may have significant hepatic fibrosis. The approach to such patients should be individualised, as further evaluation and treatment may be appropriate.