Chronic Hepatitis B (CHB) has an estimated prevalence of 90,000 to 160,000 in Australia. Cirrhosis and hepatocellular carcinoma are important complications of CHB and appropriate evaluation of HBsAg positive individuals is vital to identify treatment candidates.
Methods: A review of the database of a tertiary hospital was performed and 348 HBsAg positive individuals with baseline demographic, virological, serological and biochemical variables were identified and evaluated cross sectionally. A small subgroup of HBeAg negative patients with normal ALT at baseline were identified and followed longitudinally.
Results: 175/348 (50%) of patients were in the HBeAg negative, chronic hepatitis phase of disease, 22% in the HBeAg positive immune clearance and 6% in the immune tolerant phases. HBeAg negative patients were older and more likely to be male than HBeAg positive patients. The correlation between HBV DNA and ALT levels was examined. ALT and HBV DNA levels showed no correlation in HBeAg positive CHB and only a weak correlation in HBeAg negative patients. Furthermore, 35% of HBeAg negative patients with detectable HBV DNA had a normal ALT. Conversely 38% of HBeAg negative patients with no detectable HBV DNA had an elevated ALT. A persistently normal ALT over 24 months was seen in 5 of 9 HBeAg negative patients with normal initial ALT and detectable HBV DNA.
Conclusion: Appropriate evaluation of HBeAg negative CHB must include HBV DNA since the ALT is not a reliable guide to underlying viral replication.