Revisiting the natural history of chronic hepatitis B: Impact of new concepts on clinical management
Version of Record online: 19 APR 2007
Journal of Gastroenterology and Hepatology
Volume 22, Issue 7, pages 973–976, July 2007
How to Cite
Yuen, M.-F. (2007), Revisiting the natural history of chronic hepatitis B: Impact of new concepts on clinical management. Journal of Gastroenterology and Hepatology, 22: 973–976. doi: 10.1111/j.1440-1746.2007.04938.x
- Issue online: 19 APR 2007
- Version of Record online: 19 APR 2007
- Accepted for publication 7 January 2007.
- alanine aminotransferase level;
- chronic hepatitis B;
- hepatitis B e antigen seroconversion;
- hepatitis B virus DNA;
- natural history
Appropriate treatment for chronic hepatitis B (CHB) to prevent disease progression and clinical complications requires an accurate knowledge of the natural history of this disorder. In patients who acquire the disease in early life, as is the situation in Asian CHB patients, complications of CHB continue to develop because of the prolonged insidious damage to the liver, even in the low viremic phase. Hepatitis B e antigen seroconversion with hepatitis B virus (HBV) DNA levels just below 105 copies/mL may not be an adequate treatment endpoint for Asian CHB patients. Furthermore, it has been shown that patients with mild elevation of alanine aminotransferase (ALT) levels are already at considerable risk of development of complications. More recent studies have shown that in order to move towards a better disease outcome, CHB patients should have HBV DNA levels at least less than 103 copies/mL, with ALT levels preferably in the range of less than 0.5 times the upper limit of the normal range. Therefore, prolonged, adequate suppression of viral replication should be the practical goal for the treatment of CHB disease in the Asian population.