Alanine aminotransferase activity and its clinical significance in patients with chronic hepatitis B

The incidence of chronic hepatitis B (CHB) in Russia is not decreasing, despite the ongoing vaccination of the population. The relevance of chronic hepatitis is due to the risk of outcomes, such as cirrhosis and primary cancer of the liver, the prevention of which requires timely antiviral therapy. The leading criterion for the therapy is the high serum concentration of hepatitis B virus (HBV) DNA whereas the significance of the activity of alanine aminotransferase (ALT) is discussed. Objective. To identify the clinical significance of the level of ALT activity in patients with CHB. Subjects and methods. During the investigation, more than 250,000 patients were tested for serum hepatitis B surface antigen (HBsAg). ALT activity was identified in the persons who had been found to have HBsAg. Qualitative and quantitative assessments of HBV DNA were made in HBsAg-positive individuals. Groups of patients with different ALT activities and viral load were studied. Non-invasive assessment of liver fibrosis was carried out in CHB patients with normal ALT activity. Results. The prevalence of HBsAg in the Moscow Region amounted to 4.1%. Serum HBV DNA was detected in 63.3% of the HBsAg-positive examinees and a high viral load was found in 20.0%. High ALT levels were observed more often in males and patients older than 30 years. The combination of ALT activity > 2 N and viremia > 20,000 IU/ml suggests that the course of CHB is active and requires etiotropic therapy. Normal ALT activity levels and viremia < 20,000 IU/ml do not rule out the active course of CHB in HBsAg-positive patients.

chronic hepatitis B, HBsAg-positive persons, alanine aminotransferase, serum HBV DNA level