Brief Articles
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Jun 28, 2009; 15(24): 3025-3031
Published online Jun 28, 2009. doi: 10.3748/wjg.15.3025
Lower baseline ALT cut-off values and HBV DNA levels better differentiate HBeAg(-) chronic hepatitis B patients from inactive chronic carriers
Nimer Assy, Zaza Beniashvili, Agness Djibre, Gattas Nasser, Maria Grosovski, William Nseir
Nimer Assy, Zaza Beniashvili, Agness Djibre, Liver Unit, Ziv Medical Center, Zefat 13100, Israel
Nimer Assy, Technion Faculty of Medicine, Haifa 32000, Israel
Gattas Nasser, Department of Internal Medicine, Nahariya Hospital, Nahariya 22100, Israel
Maria Grosovski, Department of Biotechnology, Ort Braude College, Karmiel 21610, Israel
William Nseir, Department of Internal Medicine, Holy Family Hospital, Nazareth 16224, Israel
Author contributions: Assy N designed and performed the research and wrote the paper; Beniashvili Z and Djibre A performed the research; Nasser G contributed to the design and analyzed data; Grosovski M performed blood work and analysis; Nseir W contributed to the design and data analysis.
Correspondence to: Assy Nimer, MD, Liver Unit, Ziv Medical Center, Zefat 13100, Israel.
Telephone: +972-46828442
Fax: +972-46828442
Received: May 20, 2009
Revised: May 27, 2009
Accepted: June 3, 2009
Published online: June 28, 2009

AIM: To determine whether new cut-off values for alanine aminotransferase (ALT) and baseline hepatitis B virus (HBV) DNA levels better differentiate HBeAg(-) chronic hepatitis B (CHB) patients from inactive chronic carriers.

METHODS: Ninety-one patients [32 HBeAg(+) CHB, 19 inactive carriers and 40 HBeAg(-) CHB] were followed up for 2 years and were tested for HBV DNA levels by a PCR-based assay. ALT was tested twice during the last 6 mo using new cut-off values: ULN (upper limit of normal) 30 IU/L for males, 19 IU/L for females. Diagnostic accuracy, sensitivity, specificity, positive and negative predictive values were calculated by discriminant analysis.

RESULTS: When using the revised ALT cut-off values, the lowest optimal HBV DNA level that differentiated HBeAg(-) CHB patients from inactive carriers was 50 000 copies/mL. The diagnostic accuracy of HBV DNA to determine inactive carriers with a cut-off of 50 000 copies/mL was similar to the previously recommended cut-off of 100 000 copies/mL (91%). HBV DNA levels were lower than the cut-off value in 95% of inactive carriers and in 28% of HBeAg(-) CHB patients. With ALT < 30 IU/L in men and < 19 IU/L in women and HBV DNA levels < 100 000 copies/mL, the risk of CHB is 5%. On the other hand, if ALT values were > 30 IU in men and > 19 IU in women and baseline HBV DNA levels were > 100 000 copies/mL, the risk is 86%.

CONCLUSION: New cut-off values for ALT together with HBV DNA levels proposed by AASLD (American Association for the Study of Liver Diseases) and NIH (National Institute of Health) consensus seem appropriate to characterize inactive carriers.

Keywords: Alanine aminotransferase, Chronic hepatitis B, Hepatitis B antigens, Viral DNA