Anti-viral effect in chronic hepatitis B patients with normal or mildly elevated alanine aminotransferase

Normal/mildly elevated ALT (<2 × ULN) CHB patients are potentially at risk of progression to cirrhosis and/or hepatocellular carcinoma (HCC). We aimed to assess the outcomes of anti-viral therapy for normal/mild elevation of ALT CHB patients. CHB patients (n = 432) who have had liver biopsied were determined. It was determined that the outcomes of anti-viral therapy in CHB patients with normal/mild elevation of ALT, in response to nucleoside/nucleotide analogues (NAs) (n = 190) and pegylated interferon (PEG-IFN) (n = 30) treatment for up to 72 weeks. Non-anti-viral treated patients were used as control (n = 40). There was about 50% of the CHB patients showed hepatic inflammatory necrosis ≥ G2 and/or fibrosis ≥ S2 among >30-years-old. The rate of undetectable HBV DNA in NAs and PEG-IFN groups was ~50%, ~80% or ~90% at week 24, 48 or 72, respectively. HBeAg clearance rate was lower in NAs treated than that in PEG-IFN group at week 48 (6% vs 20%, P < 0.05). ALT normalization rate was increased by 1.18-fold at week 72. HBsAg decline in HBeAg + patients treated with NAs or PEG-IFN was 0.418 or 1.217 log IU/mL (P < 0.0001) at week 48; whereas HBsAg decline was 0.176 or 0.816 log IU/mL (P < 0.001) in HBeAg − patients. HBsAg at baseline and week 24 were strong predictors of “low HBsAg at week 48”. Long term anti-viral therapy inhibits HBV replication effectively in ALT<2 × ULN CHB patients. PEG-IFN therapy is recommended for HBeAg + patients with baseline HBsAg<4.37 log IU/ml and HBeAg − patients with baseline HBsAg<2.66 log IU/ml to achieve “low HBsAg at week 48”. • CHB patients with persistently normal or slightly elevated ALT (<2 × ULN) may eventually progress into cirrhosis or HCC. • We determined the anti-viral effect (NAs or PEG-IFN) in CHB patients with ALT < 2 × ULN, determined by liver biopsy. • Long term NAs or PEG-IFN inhibits HBV replication effectively in normal/mildly elevated ALT CHB patients. • PEG-IFN is recommended for HBeAg + or HBeAg − patients with baseline HBsAg<4.37logIU/ml or baseline HBsAg<2.66logIU/ml. CHB patients with persistent normal/mildly elevated blood liver function are potentially at risk of progression of liver damage, mainly due to persistent liver damage sub clinically. Anti-viral medication is strongly recommended for these CHB patients to reduce the chance of development of hepatocellular carcinoma.