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Antivirals Benefit Hep B Patients With Normal or Elevated ALT Study
AASLD 2015
November 17, 2015
Antivirals Benefit Hep B Patients With Normal or Elevated ALT
SAN FRANCISCO, CA—Antiviral therapy in patients with non-cirrhotic chronic hepatitis B (CHB) and normal to minimally-elevated alanine aminotransferase (ALT) levels significantly reduced the risk of hepatocellular carcinoma (HCC), reported Joseph K. Hoang from Stanford University Medical Center, Palo Alto, CA, at The Liver Meeting® 2015.
"In patients with ALT less than 2 times ULN [upper limit of normal], we also observed significantly higher HCC incidence in untreated patients compared to treated patients," the research team reported. Non-cirrhotic patients with ALT less than 2 times ULN who are older than 40 may benefit from antiviral therapy, they concluded.
The AASLD guideline for CHB identify ALT ≥2 times ULN as a major criteria to initiate antiviral therapy.
"However, patients with ALT less than 2 times the ULN may still be at risk for future complications such as HCC," the researchers explained. They therefore sought to evaluate whether ALT levels below the AASLD guidelines threshold also affect HCC risk in patients with noncirrhotic CHB.
Their team performed a retrospective cohort study of 3,649 treatment-naïve, non-cirrhotic CHB patients age ≥40 years who had been evaluated at 4 U.S. clinics between 1991 and 2014, and in Taiwan during 1991–1992 as part of the REVEAL HBV Cohort. Patients were categorized as either ALT ≥2 x ULN (30 IU/L for men; ≥19 IU/L for women) or <2 x ULN.
In both categories, treated patients had significantly lower HCC incidence rates than untreated patients.
"At 10-year follow-up, the cumulative probability of developing HCC [in the ALT <2x ULN category] was 0.9% in the untreated group and 0% in the treated group," (P=0.0042) the researchers reported. For the ALT ≥2 x ULN category, the cumulative probability of HCC at 10-year follow-up was 12.7% vs. 5.2% in untreated and treated patients, respectively (P<0.0218), the researchers reported.
REACH-B score was a "significant, independent predictor of HCC, with each point increase in REACH-B score associated with a 36% increase in the development of HCC," they reported (hazard ratio [HR] 1.59; 95% CI: 1.49, 1.70; P<0.0001).
November 17, 2015
Antivirals Benefit Hep B Patients With Normal or Elevated ALT
SAN FRANCISCO, CA—Antiviral therapy in patients with non-cirrhotic chronic hepatitis B (CHB) and normal to minimally-elevated alanine aminotransferase (ALT) levels significantly reduced the risk of hepatocellular carcinoma (HCC), reported Joseph K. Hoang from Stanford University Medical Center, Palo Alto, CA, at The Liver Meeting® 2015.
"In patients with ALT less than 2 times ULN [upper limit of normal], we also observed significantly higher HCC incidence in untreated patients compared to treated patients," the research team reported. Non-cirrhotic patients with ALT less than 2 times ULN who are older than 40 may benefit from antiviral therapy, they concluded.
The AASLD guideline for CHB identify ALT ≥2 times ULN as a major criteria to initiate antiviral therapy.
"However, patients with ALT less than 2 times the ULN may still be at risk for future complications such as HCC," the researchers explained. They therefore sought to evaluate whether ALT levels below the AASLD guidelines threshold also affect HCC risk in patients with noncirrhotic CHB.
Their team performed a retrospective cohort study of 3,649 treatment-naïve, non-cirrhotic CHB patients age ≥40 years who had been evaluated at 4 U.S. clinics between 1991 and 2014, and in Taiwan during 1991–1992 as part of the REVEAL HBV Cohort. Patients were categorized as either ALT ≥2 x ULN (30 IU/L for men; ≥19 IU/L for women) or <2 x ULN.
In both categories, treated patients had significantly lower HCC incidence rates than untreated patients.
"At 10-year follow-up, the cumulative probability of developing HCC [in the ALT <2x ULN category] was 0.9% in the untreated group and 0% in the treated group," (P=0.0042) the researchers reported. For the ALT ≥2 x ULN category, the cumulative probability of HCC at 10-year follow-up was 12.7% vs. 5.2% in untreated and treated patients, respectively (P<0.0218), the researchers reported.
REACH-B score was a "significant, independent predictor of HCC, with each point increase in REACH-B score associated with a 36% increase in the development of HCC," they reported (hazard ratio [HR] 1.59; 95% CI: 1.49, 1.70; P<0.0001).
Normal ALT value for males is up to 30, for females up to 19.
With that said, ALT tends to be on average a bit higher for those aged 35-45, so if one is in that age range a 2-3IU increase of ALT might not really matter and according to my personal understanding might be considered a normal.
With that said, ALT tends to be on average a bit higher for those aged 35-45, so if one is in that age range a 2-3IU increase of ALT might not really matter and according to my personal understanding might be considered a normal.
What was the last Alt # of SafiSafa when his doctor told him HBV free? We can take his Alt as a reference, right?
The normal range of ALT is 4-36 IU/L in most laboratories. It is based on general population, it might be slightly different depending on the population.
Very interesting. It's very unfortunate I cannot test hbsag quant or try peg in the US. I'm thinking in time with what treatments may come available the US will have to start allowing qHbsAg. Also, the US doctors I've all been to do not use peg but maybe down the road with better treatments this will be eliminated or they will be forced to combine with peg. Very frustrating. I thank you for you sharing your personal history on alt, it makes sense.
1 Comments
It makes sense.
As per my understanding on your and Steff's example seems that HBsAg quantity is directly proportional to ALT value. For Stef,
For 1500iu/ml ATL went 20-26
For 699-1000iu/ml ATL 16-20
For my case,
for 4400 iu/ml ATL was 39.
All of us have HBeAg negative and almost less/undetected Viral load(With/Without treatment).
Do you have any idea how much will be the normal value of ALT for whom HBV is negative?
This example gives us to guess HBsAg value depending on the ALT. It's my guess. Please othersa can suggest!!
As per my understanding on your and Steff's example seems that HBsAg quantity is directly proportional to ALT value. For Stef,
For 1500iu/ml ATL went 20-26
For 699-1000iu/ml ATL 16-20
For my case,
for 4400 iu/ml ATL was 39.
All of us have HBeAg negative and almost less/undetected Viral load(With/Without treatment).
Do you have any idea how much will be the normal value of ALT for whom HBV is negative?
This example gives us to guess HBsAg value depending on the ALT. It's my guess. Please othersa can suggest!!
i also noticed that antivirals did not make my alt normal less than 30, in the 4-5th year of nucs it was still around 30
the only thing that made my alt really low in the normal range is when peg moved my hbsag to less than 1500iu/ml and alt went 20-26 and when hbsag hit 699-1000iu/ml alt 16-20
of course these are just observations but i guess better immune control correlates to lower alt in my case, anyone can be different on this
the only thing that made my alt really low in the normal range is when peg moved my hbsag to less than 1500iu/ml and alt went 20-26 and when hbsag hit 699-1000iu/ml alt 16-20
of course these are just observations but i guess better immune control correlates to lower alt in my case, anyone can be different on this
Thanks for your help. I will for sure be asking next month! I have been testing ALT and DNA for almost 20 years and have kept copies of labs (every 6 month testing both) since 2005. They have all remained very consistent, with more fluctuation in DNA, but do not have any lab above that 2000 Iu. We will see if DNA will remain lower with me going off Viread. :/
Stephen was nice enough (thanks again) to provide the abstract information for this study. It's abstract poster 1561.
http://www.aasld.org/sites/default/files/2015SupplementFULLTEXT.pdf
Stephen was nice enough (thanks again) to provide the abstract information for this study. It's abstract poster 1561.
http://www.aasld.org/sites/default/files/2015SupplementFULLTEXT.pdf
If your ALT stayed in the same range even when you were taking Viread than there might be a different cause of your slight ALT elevation. Bring it up on your next appointment with your liver specialist.
Being a female your risk of liver cancer is minimal, especially since your DNA is staying bellow 2000 IU. How frequently are have you been checking HBV DNA?
Being a female your risk of liver cancer is minimal, especially since your DNA is staying bellow 2000 IU. How frequently are have you been checking HBV DNA?
I subscribe to the hepatitis b foundation on Facebook. Each day they post something related to HBV and today this was one of them. I just copied and pasted the information but if you search their website maybe you can find more. I think I will do the same, good information.
My DNA without treatment has fluctuated from 120 iu/ml all the way to 1270 iu (back in 2007). I haven't seen higher than these numbers in 12+ years of labs every 3-6 months.
I don't know why my alt has been now considered elevated all these years, when I thought it was in the normal range. I was on Viread for 6 months (doctor said to lower HCC risk) and alt didn't change, stayed consistent around 26-29. I went off medication per Dr. Gish's recommendation, as he felt I didn't need it to begin with? Now with these new alt and HCC cancer guidelines will be asking about meds again next time I see my doctor.
My DNA without treatment has fluctuated from 120 iu/ml all the way to 1270 iu (back in 2007). I haven't seen higher than these numbers in 12+ years of labs every 3-6 months.
I don't know why my alt has been now considered elevated all these years, when I thought it was in the normal range. I was on Viread for 6 months (doctor said to lower HCC risk) and alt didn't change, stayed consistent around 26-29. I went off medication per Dr. Gish's recommendation, as he felt I didn't need it to begin with? Now with these new alt and HCC cancer guidelines will be asking about meds again next time I see my doctor.
What is the source of this info?
I am trying to locate the research abstracts of these 2 studies...
I am trying to locate the research abstracts of these 2 studies...
Thx for this pointing on this very important study...
How was your HBV-DNA going...was it undetected most of the time or had some other pattern?
How was your HBV-DNA going...was it undetected most of the time or had some other pattern?
To me, ULN 19 iu/l is too low. I have never seen any lab set that low ULN. Even if it is, you are still in the ALT<2xULN category.. Based on the study result, you could get benefit to initiate antiviral therapy to prevent HCC.
Questions regarding this study in relation to my personal history.
I've been monitoring my HBV consistently for well over a decade and have been hbeag negative for at least 20+ years with DNA never above that 2,000 iu/ml. I'm female, 42, but as far back as I have labs (12 years) my ALT has NEVER been 19 or lower. It hoovers around 25-28, but once saw 23 and once saw 34, but of course all these numbers still within the reference range.
My fibroscan in September was 4.2 kpa and I've had 2 biopsies in 10 years and both were good and of no concern. On another note, I am not overweight (5'7 and 120 lbs), eat healthy, and work out daily.
I've read ALT is a poor indicator of liver damage, so in my case since my liver has been in good health even though ALT is now considered high what should I do? Treat like article says? Continue to monitor like always?
I've been monitoring my HBV consistently for well over a decade and have been hbeag negative for at least 20+ years with DNA never above that 2,000 iu/ml. I'm female, 42, but as far back as I have labs (12 years) my ALT has NEVER been 19 or lower. It hoovers around 25-28, but once saw 23 and once saw 34, but of course all these numbers still within the reference range.
My fibroscan in September was 4.2 kpa and I've had 2 biopsies in 10 years and both were good and of no concern. On another note, I am not overweight (5'7 and 120 lbs), eat healthy, and work out daily.
I've read ALT is a poor indicator of liver damage, so in my case since my liver has been in good health even though ALT is now considered high what should I do? Treat like article says? Continue to monitor like always?
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