Hepatitis B inactive carriers: Clinical course and outcomes

Objective Hepatitis B virus (HBV) inactive carriers are HBV e antigen (HBeAg)-negative patients with normal alanine aminotransferase (ALT) levels and HBV DNA of 10000 copies/mL. We aimed to determine the clinical impact of ALT and HBV DNA elevations during the course of HBV infection. Methods From January 1989 to January 2012, 146 inactive carriers were prospectively followed every 612 months with ALT and HBV DNA measurements and with hepatocellular carcinoma (HCC) surveillance. Results During the follow-up of 8 +/- 6.3 years, 56 of the 146 patients maintained ALT 40U/L and HBV DNA10000copies/mL. However, 39 had rises of ALT > 4080U/L and 4 had ALT > 80U/L; all except one reverted to baseline values. Also, during follow up, 69 (47.3%) inactive carriers had increases in HBV DNA of > 10000999999 copies/mL; 38 of these patients' HBV DNA returned to baseline levels, while the remaining 31 patients maintained elevated HBV DNA values but had corresponding ALT of 40U/L. There were four liver-related outcomes: 129 (88.4%) remained inactive carriers, 13 (8.9%) had loss of hepatitis B surface antigen (HBsAg), one (0.7%) had a spontaneous reactivation to HBeAg-negative chronic hepatitis, and two (1.4%) developed HCC. Conclusions Although the prognosis of inactive carrier is favorable, transient ALT and HBV DNA elevations may be observed but have minimal clinical significance. Moreover, continuous HCC surveillance remains necessary since the risk of development still exists.