Is Liver Biopsy Necessary in Patients with Chronic Hepatitis B with Normal Alanine Aminotransferase Level?

Objectives: If not treated early, morbidity and mortality will remain high in hepatitis B virus infection. In this study, it was aimed to analyze the liver biopsy results of patients with chronic hepatitis B with normal alanine aminotransferase (ALT) levels. Materials and Methods: The study was conducted retrospectively. The patients who were admitted in the infectious diseases and clinical microbiology outpatient clinic, had liver biopsy and received treatment between 01.09.2019 and 01.12.2019, were included. Results: A total of 169 patients were included in the study. Of the individuals, 95 (56.2%) were female, with a mean age of 42.4±11.15 years. The rates of having an histological activity index (HAI) score of 6/18 and above and a fibrosis stage of 2/6 or more (90%, 100%, respectively) in patients with ALT level above upper limit of normal (ULN) were higher than in patients with ALT level belowULN (63.6% and 79.1%, respectively) (p=0.001 and p=0.002, respectively). When 129 patients with ALT level below ULN were evaluated in subgroup analyses. HAI score was 6 or higher in 59 (58.4%) of the hepatitis B e antigen (HBeAg) negative patients, and fibrosis stage was 2 or higher in 76 (75.2%) patients. In patients with ALT below ULN and HBeAg positivity, the rates of HAI score of 6 and above and fibrosis stage of 2 and above were found to be statistically significantly higher than in HBeAg negative patients. Conclusion: Liver fibrosis and necroinflammation may develop in patients with normal ALT levels. In making the biopsy decision, ALT level should be considered together with other factors that may affect liver damage.