Evaluation of the need for treatment on 72 subjects with anti-HBe positive chronic hepatitis B

Background: Viral load and alanine aminotransferase (ALT) levels may not be the key points for making a decision in the treatment of anti-HBe positive chronic hepatitis B. The purpose of this study was to assess the histological evaluation of liver to find the need for treatment on 72 patients with anti-HBe positive chronic hepatitis B. Methods: The liver biopsy slides of the 72 patients (56 subjects with viral load >105 with any ALT levels, 16 cases with viral load <105 copies/ml with abnormal ALT levels) were evaluated at the Department of Pathology, Babol University of Medical Sciences, Iran from April 2006 to August 2011. Ishak Scoring system was used to determine the hepatitis activity index (HAI) and fibrosis score. Those with total score >3 were considered for treatment. Data were collected and analyzed. Results: The mean age of the patients was 34.4±12 years. The mean ALT level was 105±10.5 IU/L. The mean HAI with viral loads more or less than >105 was 5.9±2.6 and 4±1.9, respectively (p=0.04). HAI >3 was seen in 9 (56.3%) and in 43 (76.8%) subjects with viral loads <105 and > 105 copies/ml (p<0.05). No fibrosis was seen in 25 (34.7%) of these cases. Fibrosis stage regarding viral loads more or less than105 copies/ml was equal (p=0.12). The need for treatment was seen in 62 (86%) patients. Conclusion: The results show that any viral load values may cause significant injuries that need to treatment. Liver biopsy is indicated in any case of anti-HBe with any viral loads with increased ALT levels.