Author/Authors :
Hooshyar، Afshin نويسنده Department of Gastroenterology, Imam Khomeini Hospital, Ardabil University of Medical Sciences, Ardabil, IR Iran Hooshyar, Afshin , Habibzadeh، Shahram نويسنده , , Ghasemi، Nasrin نويسنده , , Yazdanbod، Abbas نويسنده , , Sohrabi، Sirus نويسنده Department of Emergency medicine, Shahid Beheshti University of Medical sciences, Tehran, IR Iran Sohrabi, Sirus , Maleki، Nasrollah نويسنده Department of Internal Medicine, Imam Khomeini Hospital, Ardabil University of Medical Sciences, Ardabil, IR Iran Maleki, Nasrollah , Amani، Firooz نويسنده Department of Social Medicine, Ardabil University of Medical sciences, Ardabil, IR Iran Amani, Firooz
Abstract :
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 serum
alanine aminotransferase (ALT) levels, 1-2 × upper limit of normal (ULN) and HBV DNA load of 10000 to 100000 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 samples
present in various populations. Objectives: Liver histopathology in asymptomatic patients with greater than 10000 DNA copies/mL despite negative Hbe Ag was studied
to determine, the number of people that will benefit from a liver biopsy, and variables that will significantly be affected by viral load
changes. 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.
