2024
Chronic Inactive Hepatitis B Virus: More Benign Than We Think!
Abdalla Hassan, MD1, Winnie Sheu Woc , MD1, Ayman Abdo, MD2, Dana Villiens1. 1. Advocate Illinois
Masonic Medical Center, Chicago, IL; 2. King Khalid University Hospital, King Saud University, Riyadh,
Saudi Arabia.
Introduction: Hepatitis B virus (HBV) is one of the most common viral infections worldwide, the natural
history of which does not always progress in a linear fashion. We aimed to identify the natural history
of chronic inactive hepatitis B virus over the course of 15 years, and to describe the changes in the liver
condition using AST platelet ratio index (APRI) score as a measure of liver fibrosis.
Methods: Th is is a prospective cohort study following 69 patients aged 30-60 years who have had
inactive hepatits B virus for 15 years. APRI score was calculated at the time of diagnosis and 15 years
later. Inactive hepatitis B virus was identified as PCR < 2000 with normal liver enzymes and no clinical
symptoms regardless of their HBe Ag status. APRI score was used as a non-invasive measure of
liver fibrosis.
Results: Of the 69 patients, 37 were females (54%), and 32 were males (46%). Upon diagnosis, 87%
percent of patients were Hepatitis eAg negative, while only 13% were positive. At the end of the 15 year
follow-up, 93% of patients were Hepatitis e Ag negative. At the time of diagnosis, the mean APRI score
was 0.33 ± 0.17 suggestive of minimal fibrosis and the mean bilirubin was 9.6 ± 6.8 μmol/L. However,
15 years later, the mean APRI score remained 0.33 ± 0.36. (P=.12) while the mean bilirubin decreased to
8.5 ± 4.5 μmol/L (P= < .001).
Conclusion: The natural history of hepatitis B is variable and multifactorial; the main component is the
activity level of the virus. There is limited data on the natural history of inactive hepatitis B virus, and our
study is one of the few long-term prospective studies to be done on this category of hepatitis B patients.
Based on these results, we believe that inactive hepatitis B virus is more benign than what is commonly
thought, with minimal risk of liver damage, even long term. Additional large scale prospective studies are
needed to validate these results and to improve our overall understanding of the nature of the inactive
form of this virus.