High Normal Alanine Aminotransferase is an Indicator for Better Response to Antiviral Therapy in Chronic Hepatitis B

Objective: To investigate liver histologic disease in chronic hepatitis B (CHB) patients with normal ALT (<40U/L), as well as to evaluate the potential benefits of antiviral therapy for these patients, and to establish a management strategy for them. Methods: We retrospectively examined 1352 patients who underwent liver biopsy from 2017 to 2021 and then obtain their 1-year follow up data to establish a predict model of 1-year HBVDNA clearance rate through Logistic regression. Results: The proportion of patient with significant histological disease (significant liver necroinflammation or fibrosis) in the high nALT group was significantly higher than that in the low nALT group (56.43% vs 43.82%, p < 0.001, Table 1). HbeAg negative, GGT and ALT value (OR 0.024, 95% CI 0.011–0.055, p < 0.001; OR 1.027, 95% CI 1.006–1.050, p = 0.013; OR 1.993,95% CI 1.115–3.560, p = 0.020, Table 4) were independent predict factors. High normal ALT is an indicator of 1-year HBVDNA clearance after antiviral treatment. Conclusion: CHB patients with high-normal ALT have significantly higher histological disease rates, and these patients may benefit better from antiviral therapy. We suggest should undergo histological evaluation of liver disease as soon as possible. We also propose these patients should be offered antiviral therapy when feasible.