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Guidelines vary on how often asymptomatic hepatitis B virus (HBV)-infected, hepatitis B e antigen (HBeAg)-negative patients with normal alanine aminotransferase (ALT) levels should be monitored. Determining optimal monitoring frequency is difficult because little data exist on the predictive factors or frequency of spontaneous ALT flares (i.e., reactivation of the virus) in these patients.
To address this issue, investigators at a single center in India prospectively studied 217 asymptomatic, treatment-naive patients who had chronic HBV for at least 6 months, were HBeAg-negative, anti-HBeAg-positive, and had normal ALT levels (<40 IU per L). Patients were excluded if they had hepatitis A, C, D, or E; HIV coinfection; decompensated liver dise…