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HBV Fibrosis Progression - avg 4-5 year / stage with elevated ALT
Fibrosis progression rates between chronic hepatitis B and C patients with
elevated alanine aminotransferase levels.

Fujiwara A, Sakaguchi K, Fujioka S, Iwasaki Y, Senoh T, Nishimura M, Terao M,
Shiratori Y.
Department of Gastroenterology and Hepatology, Okayama University Graduate
School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata,
Okayama, 700-8558, Japan.

BACKGROUND: We evaluated the annual rate of fibrosis progression in chronic
hepatitis B and C patients with elevated alanine aminotransferase (ALT)
levels. METHODS: Forty-nine chronic hepatitis B patients and 21 chronic
hepatitis C patients, each of whom had undergone two or more liver biopsies at
an interval of more than 1 year, were enrolled in this retrospective clinical
research protocol. The annual rate of fibrosis progression was calculated by
dividing the change in fibrosis stage between the first and second liver
biopsies by the interval in years between them. RESULTS: The median interval
in chronic hepatitis B and C was 3.4 (first and third quartiles, 1.8-4.7) and
3.2 (2.1-6.5) years, respectively. Overall, the mean fibrosis progression rate
was 0.21 +/- 0.31 (mean +/- SD) fibrosis units (FU) per year in 49 patients
with chronic hepatitis B, and 0.13 +/- 0.18 FU/year in 21 patients with
chronic hepatitis C. The ALT level was an independent variable correlating
with fibrosis progression. In patients whose median ALT level was 70 IU/l or
more, the mean fibrosis progression rate was 0.28 +/- 0.32 FU/year in 36
patients with chronic hepatitis B, and 0.22 +/- 0.23 FU/year in eight patients
with chronic hepatitis C. CONCLUSION: This paired-biopsy study of untreated
chronic hepatitis B or C demonstrated that fibrosis progression occurred
largely in patients with continuously elevated ALT levels even over a
relatively short period, and that liver fibrosis might progress by one stage
within an average of 4-5 years of follow-up in patients with elevated ALT of
70 IU/l or more.
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This study seems to say elevated ALT is a sensitive indicator for liver fibrosis.  ALT is a faster and maybe less expensive test.  On the other hand, there are many causes that can elevate ALT.
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I saw this one this morning.  It was interesting for me because I have had elevated ALT for at least 10 years.  Mine never got over 69 and is more typically in the 40s.  I liked this study b/c it gave particulars about ALT instead of the more general 1.5 x ULN where normal is not stated.  
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