Hepatitis B inactive carriers: Clinical course and outcomes

Authors

  • Myron J. Tong,

    Corresponding author
    1. Pfleger Liver Institute, University of California, Los Angeles, California, USA
    2. Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, California, USA
    • Liver Center, Huntington Medical Research Institutes, Pasadena
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  • Judy Trieu

    1. Liver Center, Huntington Medical Research Institutes, Pasadena
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  • Conflict of interest: None.

Correspondence to: Myron J. TONG, Liver Center, Huntington Medical Research Institutes, 660 South Fair Oaks Avenue, Pasadena, CA 91105, USA. Email: myrontong@hmri.org

Abstract

Objective

Hepatitis B virus (HBV) inactive carriers are HBV e antigen (HBeAg)-negative patients with normal alanine aminotransferase (ALT) levels and HBV DNA of ≤ 10 000 copies/mL. We aimed to determine the clinical impact of ALT and HBV DNA elevations during the course of HBV infection.

Methods

From January 1989 to January 2012, 146 inactive carriers were prospectively followed every 6–12 months with ALT and HBV DNA measurements and with hepatocellular carcinoma (HCC) surveillance.

Results

During the follow-up of 8 ± 6.3 years, 56 of the 146 patients maintained ALT ≤ 40 U/L and HBV DNA ≤ 10 000 copies/mL. However, 39 had rises of ALT > 40–80 U/L and 4 had ALT > 80 U/L; all except one reverted to baseline values. Also, during follow up, 69 (47.3%) inactive carriers had increases in HBV DNA of > 10 000–999 999 copies/mL; 38 of these patients’ HBV DNA returned to baseline levels, while the remaining 31 patients maintained elevated HBV DNA values but had corresponding ALT of ≤ 40 U/L. There were four liver-related outcomes: 129 (88.4%) remained “inactive carriers”, 13 (8.9%) had loss of hepatitis B surface antigen (HBsAg), one (0.7%) had a spontaneous reactivation to HBeAg-negative chronic hepatitis, and two (1.4%) developed HCC.

Conclusions

Although the prognosis of inactive carrier is favorable, transient ALT and HBV DNA elevations may be observed but have minimal clinical significance. Moreover, continuous HCC surveillance remains necessary since the risk of development still exists.

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