Clinical use of liver biopsy for the diagnosis and management of

liver411

J Med Virol. 2010 Jun 22;82(8):1350-1354. [Epub ahead of print]

Clinical use of liver biopsy for the diagnosis and management of inactive and
asymptomatic hepatitis B virus carriers in Bangladesh.

Al-Mahtab M, Rahman S, Akbar SM, Kamal M, Khan MS.

Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka,
Bangladesh.

Abstract
Patients with inactive chronic hepatitis B virus (HBV) infection are assumed
to be free from liver disease. Accordingly, antiviral drug treatment is not
recommended for these patients. However, the extent of liver damage in these
patients has not been evaluated fully. The aim of this study was to evaluate
the extent of liver damage in patients with inactive HBV. Liver biopsy was
conducted in 141 inactive HBV carriers [HBeAg-negative, low levels of HBV DNA
(</=10,000 copies/ml) and normal levels of serum alanine aminotransferase
(ALT)]. The extent of hepatic inflammation and fibrosis was evaluated in these
patients by examining liver biopsy specimens. Although the patients were
inactive HBV carriers, mild to moderate levels of necroinflammation (HAI
necroinflammation score HAI-N1>/= 7) were detected in 36 of 141 (26%)
patients. Seventeen patients had a severe degree of hepatic fibrosis (HAI
fibrosis score HAI-F>/= 3). A total of 10 patients had both considerable
necroinflammation (HAI-N1>/=7) and severe fibrosis (HAI-F>/=3). All 10
patients with significant hepatic inflammation and fibrosis were male and
older than 25 years. However, all were HBeAg-negative and expressed low levels
of HBV DNA and normal ALT levels. The study demonstrates that features of
liver damage were present in a considerable number of the patients. Assessment
of liver biopsy specimens in a larger cohort of inactive HBV carriers is
necessary to establish management guidelines for such patients.

J. Med. Virol. 82:1350-1354, 2010. (c) 2010 Wiley-Liss, Inc.

PMID: 20572087 [PubMed - as supplied by publisher]