Hepatitis B Virus Inactive Carriers: Which Follow-up Strategy?

INTRODUCTION: The natural history of patients with inactive hepatitis B virus (HBV) is still unclear, persisting doubts about the optimal management of these patients. AIM: To evaluate the long-term outcome in a cohort of hepatitis B inactive carriers. METHODS: We conducted a retrospective study in a cohort of 100 HBV inactive carriers (categorized after quarterly determinations of serum ALT and HBV DNA over one year) and analyzed the results of serial determinations of HBV DNA and alanine transaminase (ALT). The HBV DNA was quantified by Cobas TaqMan(®). We used the Spearman's rank correlation coefficient to evaluate the correlation between the serum ALT and HBV DNA. RESULTS: We studied 100 HBV inactive carriers (53% females, mean age 48.7 ± 13.8 years, range 16–77 year). Vertical transmission was identified in 18%. The mean follow-up time was 4.6 ± 2.5 (2–13) years. Two patients had transient elevation of ALT (alcohol and drugs). We observed clearance of hepatitis B surface antigen (HBsAg) in four patients (4%) and biological and virological reactivation in 10% (from the 4th year of follow-up). Mild lesions were found in the 12 patients in whom liver biopsy was performed; genotypes A and D predominated. Viral load and serum ALT levels were unremarkable in 90% of the patients. There was no significant correlation (p > 0.05) between the values of ALT and HBV DNA throughout the follow-up. CONCLUSION: The management strategy, using both patterns of biochemical and virologic activity, seems adequate. The lack of correlation between the values of ALT and HBV DNA caveat its effectiveness and the stability of the levels of HBV DNA and ALT in most patients suggests that the prognosis of the inactive carriers, when defined accurately, is mostly benign. Further studies, including ones with new tests available, are needed to standardize and improve the management of this group of patients.