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Patients with chronic hepatitis B virus (HBV) infection and persistently normal alanine aminotransferase (ALT) levels currently are not considered candidates for HBV treatment, in part because of the belief that these patients have mild histologic damage, especially if their disease is in the immune-tolerant phase.
To test the validity of this hypothesis, investigators retrospectively reviewed the results of routine liver biopsies from 192 HBV-positive patients with active viral replication: 59 had persistently normal ALT levels (defined as ALT levels ≤40 IU/L on 2 separate occasions during a 6-month period, with no history of abnormal liver enzymes), 26 had ALT levels 1–1.5× the upper limit of normal (ULN), and 107 had ALT levels >1.5× the …