Effectiveness of antiviral treatment in HBeAg-negative chronic hepatitis B patients with normal or mildly elevated alanine aminotransferase: a retrospective study

Efficacy of Antiviral Therapy in Chronic Hepatitis B Patients With Normal Alanine Aminotransferase: A Systematic Review and Meta-Analysis

Background and objectives: The efficacy of antiviral therapy in chronic hepatitis B (CHB) patients with normal alanine aminotransferase (ALT) is controversial. This study aimed to systematically review and analyze antiviral efficacy in ALT-normal CHB patients. Methods: PubMed, Embase, Web of Science, and the Cochrane Library databases from inception to 17 May 2024 were searched for retrieving relevant studies with antiviral efficacy of ALT-normal CHB patients. Results: Of 4992 records screened, 10 studies met the criteria for inclusion and had a low risk of bias. The pooled proportions of undetectable HBV DNA, HBeAg loss, HBeAg seroconversion, HBsAg loss, and HBsAg seroconversion in ALT-normal CHB patients with antiviral therapy were 87%, 35%, 19%, 16%, and 10%, respectively. Subgroup analysis suggested that the virological and serological responses were better in patients receiving IFN-based therapy or with a longer follow-up time. Compared with no treatment, antiviral therapy was associated with significant higher rates of undetectable HBV DNA (RR: 65.62, 95% CI: 16.65-258.57, and p < 0.01), HBeAg loss (RR: 14.97, 95% CI: 3.31-67.65, and p < 0.01), HBsAg loss (RR: 14.22, 95% CI: 4.10-49.29, and p < 0.01), and HBsAg seroconversion (RR: 24.65, 95% CI: 3.06-198.60, and p < 0.01). The normal ALT group and elevated ALT group had comparable antiviral efficacy including proportions of undetectable HBV DNA, HBeAg loss, and HBeAg seroconversion (p > 0.05). Conclusions: CHB patients with normal ALT could benefit from antiviral therapy, and the virological and serological responses were comparable to that of ALT-elevated ones.

Virological response and predictive factors for antiviral treatment in chronic HBV-related liver disease with low ALT and high HBV DNA

Objective

To investigate virological response and predictive factors for antiviral treatment in chronic HBV patients with low ALT and high HBV DNA.

Methods

A retrospective study grouped chronic HBV patients by baseline ALT: ALT > 80 U/L (significantly elevated group, SAG), 40-80 U/L (mildly elevated group, MAG), and ≤ 40 U/L (normal group, NG). Inverse probability treatment weighting balanced confounding factors. Complete virological response (CVR, HBV DNA < 20 IU/mL) and partial virological response (PVR, HBV DNA ≥ 20 IU/mL) were defined. NG subgroup analyses were performed using baseline ALT (cutoff: 30 U/L for males, 19 U/L for females), HBV DNA (cutoff: 7.21 Log10 IU/mL), and Aspartate Aminotransferase to Platelet Ratio Index (cutoff: 0.32). Cox regression identified factors predicting CVR at week 48.

Results

After IPTW, the number of patients in the NG, MAG, and SAG groups was 92, 141, and 284, and the CVR rates at week 48 were 38.05%, 55.26%, and 7analyses 3.32% respectively (p < 0.0001). Weighted Kaplan-Meier analysis showed that the NG group had the lowest probability of achieving CVR at week 48 (p < 0.0001). Particularly, in the NG group, the high-normal ALT subgroup had a higher CVR rate (56.34% (40/71)) than the low-normal ALT subgroup (29.73% (11/37), p = 0.0103), similar to that of the MAG group (p = 0.9871). The low-HBV DNA (82.46% (47/57)) and high-APRI subgroup (63.79% (37/58)) had higher CVR rates than the high-HBV DNA (7.84% (4/51)) and low-APRI subgroup (28% (14/50)) respectively. High HBV DNA and low ALT patients in NG had a CVR of 0% (0/18). Cox regression identified baseline ALT ≤ 30 U/L (males) or ALT ≤ 19 U/L (females), HBV DNA > 7.21 Log10 IU/mL, HBeAg positive state, APRI < 0.32, and a decrease in HBV DNA < 3.49 Log10 IU/mL at 12 weeks as independent adverse predictors of CVR.

Conclusion

The NG group has lower CVR, but the high-normal ALT subgroup performs similarly to MAG. High HBV DNA and low ALT significantly reduce CVR. Key adverse predictors include low ALT, high HBV DNA, HBeAg positivity, low APRI, and suboptimal viral reduction at 12 weeks.

High immunocompetence in chronic hepatitis patients with normal alanine transaminase levels and and negative hepatitis B e-antigen for the progression of liver fibrosis

INTRODUCTION

This study aimed to investigate the role of immunocompetence in chronic hepatitis B (CHB) patients with normal alanine transaminase (ALT) levels and negative hepatitis B e antigen (HBeAg) in the risk assessments of the progression of liver fibrosis.

METHODS

We collected the clinical data of 57 patients with CHB, with normal ALT levels and negative HBeAg from December 2020 to December 2022. With hepatitis B virus (HBV) DNA > 20 IU/mL and ALT ≤ 40 U/L, these patients had never undergone antiviral therapy. The levels of CD4+ , CD4+ CD25+ , CD8+ , and CD4+ CD25+ CD127LOW regulatory T cells (Tregs) in the patients were detected using flow cytometry; the liver stiffness measurement (LSM) values of the patients were detected using Fibroscan.

RESULTS

There was a statistically significant difference between the levels of fibrosis-4 (FIB-4) and hepatitis B surface antigen (HBsAg) when the cutoff point was HBsAg ≥ 1500 (p < .001). FIB-4 was negatively correlated with HBsAg (R = -0.291, p = .028) and positively correlated with age (R = 0.787, p < .001). LSM was negatively correlated with Treg but this correlation was not statistically significant (p > .05). Findings based on the analysis using logistic regression were as follows: (i) age was the independent risk factor when FIB-4 was used as the indicator for assessing liver fibrosis; (ii) Treg was the independent risk factor when LSM was used as the indicator for assessing liver fibrosis. When Treg was used to predict liver fibrosis, the cutoff value, diagnostic efficacy, area under the receiver operating characteristic (ROC) curve, and p value of the ROC curve were 6.875, 0.641, 0.84, and .027, respectively.

CONCLUSION

Age and Treg are independent risk factors for progressive liver fibrosis. The cutoff value of Treg > 6.81 indicates the need for timely antiviral treatment and can serve as an indicator for evaluating liver fibrosis.

A Current Management Strategy for Children with Chronic Viral Hepatitis B, Based on International and National Guidelines

BACKGROUND

Peculiarities of the course of chronic viral hepatitis B in children cause an important medical and social problem of health care, despite the implementation of modern treatment and prevention protocols. Pathogenetic mechanisms of the development and progression of viral hepatitis B infection, the presence of occult poorly diagnosed form, the impossibility of completely eliminating the virus and the specificity of the immune response in children are still not fully solved scientific problems.

MATERIAL AND METHODS

The aim of this review is to examine current strategies for the diagnosis and treatment of chronic hepatitis B in children, based on international and national guidelines.

RESULTS

A detailed analysis of modern guidelines on the course and pathogenesis of viral hepatitis B infection confirms the fact that chronic hepatitis B is characterised by a complex interaction between the immune system of the virus and the patient, whose dynamic balance is not only responsible for the various phases of chronic viral hepatitis B infection but also leads to the result of antiviral treatment.

CONCLUSION

Despite the introduction of vaccination of children against hepatitis B, the level of viral hepatitis B vaccination of children in Ukraine remains insufficient, which leads to the further spread of the infection. Currently available antiviral drugs can provide functional treatment of viral hepatitis B infection in a limited number of patients, but today's Ukrainian realities have caused a change in approach to the treatment and monitoring of patients, which may negatively affect the implementation of the key goals of the World Health Organization Global Strategy on the prevention, diagnosis and treatment of viral hepatitis.