Selected Highlights on Hepatitis B at DDW

liver411

Report by Liz Highleyman

While the primary goal of HBV treatment is to diminish viral replication, a
small amount of HBV DNA almost always remains detectable using the most
sensitive viral load tests. As Dr. Heathcote noted, before the current
generation of viral load tests became available, people with very low HBV
DNA levels would have been considered healthy carriers, and such carriers
tend to fare well. At a topic forum on Sunday devoted to hepatitis B
pathogenesis and treatment, Mauro Manno and colleagues from Italy presented results from a natural history study of asymptomatic HBV carriers (abstract #85). They found a 30-year death rate of 10% among 296 HBV surface antigen (HBsAg) positive persons (including four liver-related deaths) compared to a death rate of 9% in 157 HBsAg negative controls (including one liver-related death). The liver-related death rate among the asymptomatic carriers was only 1%, and the overall death rates among HBV antigen positive and negative persons did not significantly differ. The researchers concluded that, "HBV carrier status is not associated with an increased risk of development of liver disease and HCC."

In the light of this, use of more sensitive PCR tests that reveal extremely
low viral load levels may actually be detrimental in some cases, by
prompting physicians to treat people who do not need therapy. Whether to treat patients with low HBV viral loads, normal ALT levels, and no biopsy
results showing liver damage remains controversial. Dr. Perillo said it may
be a "disservice" to treat people who are likely to be inactive carriers,
and suggested that the less sensitive bDNA viral load test may be more
useful in indicating which patients truly have active disease. Even the
necessity for biopsies in people with low ALT and HBV DNA levels remains a
matter of debate. While Dr. Heathcote acknowledged that biopsy is "an
integral part" of HBV management, both she and Dr. Perillo suggested that
biopsy may be unnecessary if there is no plan for treatment. On the other
hand-as with HCV-ALT levels are not always a reliable indicator of liver
damage; some people have biopsies that show serious liver damage despite normal or modestly elevated liver enzymes.