normal alt is a very very poor test, liver damage is present even if alt are normal if hbvdna detactable

[stef2011]

Most HBeAg-Negative Patients with Normal ALTs and High Viral Loads Have Fibrosis
Another study has found that even people with no signs of liver damage (with normal ALT levels) can still have significant fibrosis from hepatitis B, and that viral load may be the truer indicator of liver damage among people who have hepatitis B e antigen-negative (HBeAg) hepatitis B.

Researchers compared 203 HBeAg-negative patients who had a viral load of 20,000 IU/mL or higher with a group who had lower viral loads. Liver biopsies, in which a small slice of liver tissue is examined for fibrosis, were conducted on all of them.

The patients were divided into four groups:

Group I had HBV DNA levels exceeding 20,000 IU/mL and persistently high ALT levels, which indicates dying or damaged liver cells. Fibrosis was detected in 72.7% of them.

Group 2 had HBV DNA levels exceeding 20,000 IU/mL and normal ALT levels, appearing to indicate no liver damage. Fibrosis was detected in 52.9%.

Group 3 had HBV DNA levels less than 20,000 IU/mL and elevated ALT levels. Fibrosis was detected in 57.5%.

And Group 4 had HBV DNA levels less than 20,000 IU/mL and normal ALT levels. This group had a fibrosis rate of only 18.9%.
Researchers, reporting in the Journal of Viral Hepatitis, concluded that significant fibrosis was present in a large percentage of HBeAg-negtive patients with viral loads that exceeded 20,000 IU/mL even when they had normal ALT levels. Most of the patients had HBV strain or genotype D.

Only the combination of normal ALTs and low viral load could safely predict a low risk of fibrosis, they concluded.

In a separate article in the same issue, Japanese researchers reported monitoring 104 HBeAg-negative patients with persistently normal ALTs to see what impact their viral load had on their liver health.

During the sixth year of the study, 5 patients (4.8%) had liver cancer and 14 (13.5%) had reactivation of their hepatitis—marked by increased viral load and ALT levels. At year 10, the liver cancer rate was 13.7% and the hepatitis infection reactivation rate was 15.5% in this group.

Patients with high HBV DNA levels, exceeding 100,000 IU/mL, were at most risk of cancer and infection reactivation. Surprisingly, ALT levels appeared to play no role in predicting who was at risk of liver damage.

Researchers noted that HBV DNA levels did not appear to change dramatically over the years, and their levels at the beginning of the study served as a predictor of who would develop cancer and liver damage.

“As the baseline HBV DNA level reflects the future level (of the patient’s viral load), appropriate clinical management (based on the patient’s) viral level is expected to decrease future risk,” they wrote.

[stef2011]

also regression of fibrosis and cirrhosis has nothing to do with alt level, i regressed with alt 40-50 while others didnt with alt 20 or lower....

hbvdna and fibroscan are the best to monitor regression and anti-oxidative therapy from heptech

hbsag has correlation with immune system only, no infectivity or liver damage directly

[4est]

I found the link that I was request :) http://www.hbvadvocate.org/news/HBJ8.8.htm

thanks!

[4est]

another interesting study is presented on the flowing link: http://www.hbvadvocate.org/news/NewsUpdates_pdf/News_Review_2011/HBJ-8.7.pdf

and it is about the HBV DNA levels and also some herbal intervention and also discuss about the hbsag leve and interferon response ....

[4est]

Thanks stef201!
this is very good info, this underline that HBV DNA levels (especially for HBeAg Negative ) have to be monitored even if ALT and AST are in normal range.
Can I have the links for this study ? (I want to translate this and post this on another forum (not English language) in order to keep the people informed)

thanks!