Comparative study on guidelines in determining HBV phases in Iranian patients

The aim of this study was to compare the different phases of chronic Hepatitis B virus (HBV) infection with different values for normal ALT. 

For many years upper limit of 40 IU was considered normal for ALT for both sexes, but in recent years this value is challenged and some guidelines have lowered their limit. 

In this cross-sectional study, 2000 HBsAg positive patients who were referred to Taleghani Hospital, Tehran, Iran, from 2011 through 2018 were classified in four groups according to American Association of the study of the liver disease (AASLD), European Association of the study of the liver (EASL) /Asian-Pacific Association of the study of the liver (APASL) and American Collage of Gastroenterology (ACG) guidelines. Frequency of each group based on 3 different guidelines was compared.

In HBeAg positive patients (n=100), percentage of immune tolerance phase was 43% according to AASLD cutoff for normal ALT (35 IU for men, 25 IU for women) while it was 68% and 28% with regard to EASL/APASL and ACG (30 IU for men, 19 IU for women) cutoffs respectively. In HBeAg negative patients (n=1900), 66.68% were inactive carriers according to AASLD but the percentage changed to 82.89% and 52.42% considering EASL/APASL and ACG values, respectively.

By using ACG and to a lesser extend AASLD cutoff for ALT, many patients shift from immune tolerance and inactive carrier state into immune active phase. Therefore more patients are candidates for treatment or intensive workup to determine extent of liver injury.