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The prognosis and management of inactive HBV carriers
Author(s) -
Invernizzi Federica,
Viganò Mauro,
Grossi Glenda,
Lampertico Pietro
Publication year - 2016
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.13006
Subject(s) - medicine , hepatocellular carcinoma , hbeag , hbsag , hepatitis b virus , liver disease , gastroenterology , hepatitis b , virus , immunology , virology
Patients with chronic hepatitis B virus ( HBV ) infection lacking the serum hepatitis B e antigen ( HB eAg) and with antibodies against HB eAg (anti‐ HB e), are the prevalent subgroup of HBV carriers worldwide. The prognosis of these patients is different from inactive carriers ( IC s), who are characterized by persistently normal serum alanine aminotransferase ( ALT ) and low (<2000 IU / ml ) serum HBV DNA levels, a serological profile that may also be intermittently observed in patients with HB eAg‐negative chronic hepatitis. This is why a confirmed diagnosis of IC requires quarterly ALT and HBV DNA measurements for at least 1 year, while a single‐point detection of combined HB sAg <1000 IU / ml and HBV DNA <2000 IU / ml has a robust predictive value for the diagnosis of IC . Characteristically, IC s have minimal or no histological lesions of the liver corresponding to liver stiffness values on Fibroscan of <5 kP a. Antiviral treatment is not indicated in IC s since the prognosis for the progression of liver disease is favourable if there are no cofactors of liver damage such as alcohol abuse, excess weight or co‐infection with the hepatitis C virus or delta virus. Moreover, spontaneous HB sAg loss frequently occurs (1–1.9% per year) in these patients while the development of hepatocellular carcinoma ( HCC ) is rare, at least in Caucasian patients. However, an emerging issue reinforcing the need for clinical surveillance of IC s is the risk of HBV reactivation in patients who undergo immunosuppressive therapy without receiving appropriate antiviral prophylaxis. After diagnosis, management of IC s includes monitoring of ALT and HBV DNA every 12 months with periodic measurement of serum HB sAg levels to identify viral clearance.