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Year : 2006  |  Volume : 3  |  Issue : 1  |  Page : 155-164

Management of hepatitis B viral infection with normal ALT

Consultant Gastroenterology and Hepatology, Bombay Hospital and Medical Research Centre, Mumbai, India

Correspondence Address:
Deepak Amarapurkar
D 401/402 Ameya RBI Employees Co-Op Housing Society, Plot No. 947-950, New Prabhadevi Road, Prabhadevi, Mumbai 400 025
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Source of Support: None, Conflict of Interest: None

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Alanine transaminase (ALT) levels have been routinely used in assessment of patients with chronic HBV infection for making the treatment decisions. ALT is traditionally considered to be marker of hepatocellular injury. Various studies using interferon, peg interferon, Lamivudine, Adefovir have shown the importance of elevated ALT levels in predicting the response rate to therapy. Various guidelines have recommended treating the patients of chronic hepatitis B with elevated transaminases and suggested that patients with normal ALT should not be treated. This approach needs a reappraisal. Information available to us in last decade compels to us reevaluate importance of ALT in management of chronic hepatitis B infection. With the help of available information it is reasonable to conclude that the ALT levels have poor predictability for progression of liver disease and planning treatment in patients with CHB. To conclude, patients with CHB infection with normal ALT should be considered for treatment based on the HBV DNA levels assessed by sensitive real time PCR and histological activity. Patients age and family history of liver cancer are two important parameters in considering aggressive approach in these patients.

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