Journal
JOURNAL OF INFECTIOUS DISEASES
Volume 220, Issue 9, Pages 1469-1476Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/infdis/jiz326
Keywords
ALT elevation; antiviral treatment; body mass index; chronic hepatitis B; complete viral suppression
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Funding
- National Science and Technology Major Project [2017ZX10202202]
- Natural Science Foundation of China [81772187, 81802011]
- Guangzhou Science and Technology Plan Project [201604020002, 201804020001]
- Local Innovative and Research Teams Project of Guangdong Pearl River Talents Program [2017BT01S131]
- Guangdong Natural Science and Technology Grant [2016A030313550]
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Background. Little is known about cause and intervention for alanine aminotransferase (ALT) elevation after complete viral suppression in patients with chronic hepatitis B (CHB). Methods. In this prospective cohort study, patients with CHB who were treated with nucleos(t)ide analogs and maintained undetectable levels of hepatitis B virus (HBV) deoxyribonucleic acid (DNA) for at least 6 months were enrolled. Patients were followed up at 6-month intervals, and anthropometric, biochemical, and virological assessments were performed. Results. Of 1965 patients with median follow-up of 18.36 months, one third of patients experienced ALT elevation. Baseline high body mass index ([BMI] defined as >= 25 kg/m(2)), younger age, and liver cirrhosis independently increased the risk of longitudinal ALT elevation. At the end of follow-up, 89 (4.8%) patients reverted to low BMI, and 92 (5.0%) developed to high BMI. Compared with persistent high BMI, reversion to low BMI reduced the risk of ALT elevation (adjusted odds ratio [aOR], 0.38; 95% confidence interval [CI], 0.19-0.77); compared with persistent low BMI, onset of high BMI increased the risk of ALT elevation (aOR, 1.78; 95% CI, 1.02-3.11). Conclusions. High BMI is an independent predictor for ALT elevation after complete HBV DNA suppression. Improvement of BMI may have a beneficial effect on ALT normalization and even long-term outcomes.
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