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Level of Hepatitis B Virus DNA in Inactive Carriers With Persistently Normal Levels of Alanine Aminotransferase

    Source:  Clinical Gastroenterology and Hepatology    Volume 8, Issue 6 , Pages 535-540, June 2010
  • Chia–Ming Chu

      Affiliations
    • Reprint requests Address requests for reprints to: Chia-Ming Chu, MD, Liver Research Unit, Chang Gung Memorial Hospital, 199, Tung Hwa North Road, Taipei 10591, Taiwan. fax: (886) 3-3272236
    • ,
    • Yi–Cheng Chen
    • ,
    • Dar–In Tai
    • ,
    • Yun–Fan Liaw

    published online 22 March 2010.

    Background & Aims

    Little is known about the level of hepatitis B virus (HBV) DNA in individuals with chronic, inactive HBV infections. Patients who test positive for the antibody to hepatitis B e antigen (anti-HBe) and have normal levels of alanine aminotransferase for more than 10 years have a low risk of HBV reactivation and are considered to be inactive carriers. We investigated HBV DNA levels in inactive carriers and identified factors that correlated with this state among anti-HBe–positive carriers with HBV DNA levels of 104 copies/mL or greater (5.26 copies/mL = 1 IU/mL).

    Methods

    HBV DNA levels were assayed in 250 inactive carriers with persistently normal alanine aminotransferase levels for more than 10 years. Clinical and virologic features were compared between inactive carriers (with HBV DNA levels ≥104 copies/mL) and age-matched patients with HBe antigen–negative chronic hepatitis (controls, n = 90).

    Results

    The median level of HBV DNA among inactive carriers was 3.70 log10 copies/mL (range, undetectable to 5.98 log10 copies/mL). Ninety (36%) had levels of 104 copies/mL or greater. Compared with control patients, significant differences of inactive carriers included sex (more female patients), lower HBV DNA levels, and lower prevalence of genotype C virus and the basal core promoter mutation T1762/A1764. The prevalence of the precore mutation A1896 was similar between groups. Multiple logistic regression analyses identified male sex, HBV DNA levels greater than 105 copies/mL, and the basal core promoter mutation as independent factors that correlated with active disease.

    Conclusions

    Nearly 40% of inactive carriers had HBV DNA levels of 104 copies/mL or greater. Female sex, HBV DNA levels of 104 to 105 copies/mL, and wild-type basal core promoter correlated with inactive carrier state.

    Keywords: Chronic Hepatitis B, Sex, Viral Genotype, Viral Load, Viral Mutants

    Abbreviations used in this paper: ALT, alanine aminotransferase, anti-HBe, antibody against hepatitis B e antigen, HBeAg, hepatitis B e antigen, HBsAg, hepatitis B surface antigen, HBV, hepatitis B virus

     

     Conflicts of interest The authors disclose the following: Yun-Fan Liaw has been involved in clinical trials or served as a global advisory board member of Roche, Bristol-Myers Squibb, GlaxoSmithKline, Novartis, and Gilead Sciences. The remaining authors disclose no conflicts.

     Funding This study was supported by a grant from the National Science Council of Taiwan (NSC97-2314-B-182-019-MY2).

    PII: S1542-3565(10)00251-X

    doi:10.1016/j.cgh.2010.03.006

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