Abstract

Level of alanine aminotransferase (ALT) is a marker of hepatitis B severity and response to treatment. However, measurements ALT level may be of limited utility during the immune clearance phase of chronic hepatitis B (CHB), and can be affected by age, weight, and concomitant liver disease. We performed a literature review to determine the proportion of CHB patients with levels of ALT 1-2-fold the upper limit of normal who also had significant underlying liver fibrosis (stage = 2).We performed Medline search of original manuscripts published before June 2012, their references; we also searched abstracts from the 2010 and 2011 Annual Meetings of the AASLD and 2011 and 2012 Digestive Disease Weeks. Studies were included that had =20 consecutive treatment-naïve CHB patients with =6 months follow up, histologic data, and levels of ALT 1-2-fold the upper limit of normal. Study heterogeneity was assessed by Forest plot and Q and I2 analyses. Sensitivity was measured using 1-study removed analysis.Our analysis included 8 manuscripts and 1 abstract, comprising 683 patients. Based on random-effects modeling, 48% of patients had stage = 2 fibrosis (95% confidence interval, 36%-61%). Upon sensitivity analysis, exclusion of the study that caused the greatest deflection of the pooled estimate produced a revised estimate of 43%. A subgroup of hepatitis B e-antigen-positive and -negative patients (n=168 and 170, respectively) revealed similar rates of fibrosis (41% vs 47%, P=non-significant).Despite heterogeneity in the literature, a substantial proportion of patients with slight increases in level of ALT have significant fibrosis. Given the possibility of advanced liver disease, the threshold for antiviral treatment must be individualized. Further studies are needed to investigate patients with modest increases in ALT.

View details for DOI 10.1016/j.cgh.2013.11.038

View details for Web of Science ID 000341119700011

View details for PubMedID 24361419