NECROINFLAMATION ACTIVITY AND FIBROSIS STATUS IN CHRONIC HEPATITIS B PATIENTS WITH NORMAL OR SLIGHTLY INCREASED ALT

(A PRELIMINARY STUDY)

Haris Widita(1), Stephanus Gunawan(2), Soewignjo Soemohardjo(2), Kusumowardoyo(3), and Wenny Astuti Achwan(1)

(1) Department of Internal Medicine, Mataram General Hospital

(2) Biomedical Research Unit, Mataram General Hospital

(3) Department of Pathology, Medical Faculty Airlangga University

The most important transmission route of HBV infection in Indonesia is vertical infection and early childhood horizontal transmission. As the consequence many chronic hepatitis patients existed in immunotolerant phase. The common management guidelines for such patient are monitoring without antiviral treatment. In this preliminary study we have selected patients with HBsAg positive for more than 6 months with chronic hepatitis feature in ultrasonography and agreed liver biopsy. Nineteen patient meet the criteria and 18 patients were HBeAg positive and 1 patient was HBeAg negative. From those 19 patients 14 showed normal or slighty increased ALT (< 2x upper normal limit) and 5 with ALT >2x upper normal limit. From those 14 patients histological examination using METAVIR classification showed active necroinflamation and fibrosis (more than grade 2 and stage 2) in 6 patient (42.85%), and 8 patients showed necroinflamation less than grade 2. Using conventional management guidelines at least 40% chronic Hepatitis B patients will loss the opportunity of antiviral treatment, despite the fact that those patients with significant necroinflamation will progress to hepatic cirrhosis. Thus histological assesment is invaluable for determining HBV antiviral treatment in patients with persistenly normal transaminase.

Prof. DR. Dr. Soewignjo Soemohardjo, Sp.PD-KGEH
Biomedical Clinic
Bung Karno street Num. 143
Mataram West Nusa Tenggara Indonesia
Mobile  : +628123778689
Email    : Soewignjo@gmail.com
Url        :  https://biomedikamataram.wordpress.com


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