Liver Center, Huntington Medical Research Institutes, Pasadena; Pfleger Liver Institute and the Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
Hepatitis B "inactive carriers" are HBeAg-negative patients with normal alanine aminotransferase (ALT) values and undetectable to low levels of hepatitis B virus (HBV) DNA. We sought to determine the clinical impact of ALT and HBV DNA elevations which were observed during the course of HBV infection in these patients.
From January 1989 to January 2012, 146 HBsAg-positive "inactive carriers" were prospectively followed up in a community hospital clinic. Laboratory tests including ALT and HBV DNA measurements and hepatocellular carcinoma (HCC) surveillance were performed every 6-12 months.
During a mean follow-up of 8.0 ± 6.3 years, 56 (38.3%) of 146 patients maintained ALT ≤40 U/L and HBV DNA ≤ 10 000 copies/mL. However, 39 (26.7%) had rises of ALT >40-80 U/L and 4 (2.7%) had ALT >80 U/L, all of which subsequently reverted to baseline values, except for one patient whose ALT and HBV DNA simultaneously elevated to 467 U/L and 15 400 000 copies/mL, respectively. Also, during follow-up, 69 (47.3%) "inactive carriers" had increases in HBV DNA >10 000-999 999 copies/mL. At the last follow-up visit, 38 of these patients' HBV DNA values had returned to baseline levels, while the remaining 31 patients had levels of HBV DNA between >10 000-999 999 copies/mL; in these latter patients, the corresponding ALT values were ≤40 U/L. Four liver-related outcomes were noted: 129 (88.3%) remained "inactive carriers", 13 (8.9%) had loss of HBsAg, 1 (0.7%) had spontaneous reactivation of HBV requiring antiviral therapy, and 2 (1.4%) developed HCC.
Although the prognosis is favorable in "inactive carrier" patients, transient ALT and HBV DNA elevations may be observed during its clinical course but appears to have minimal significance. Also, continual surveillance remains necessary since the risk for HCC still exists.