Effectiveness of antiviral treatment in HBeAg-negative patients with normal or mildly elevated alanine aminotransferase: a retrospective study

Background: Few studies have assessed the effects of antiviral treatment in hepatitis B e-antigen (HBeAg)-negative patients with normal or mildly elevated alanine aminotransferase (ALT). This study aimed to investigate the effects of antiviral treatment in these patients. Methods We retrospectively analysed the outcomes of antiviral treatment in HBeAg-negative patients with normal or mildly elevated ALT who were treated nucleoside/nucleotide analogues (NAs) for up to 96 weeks. Results Overall, 128 patients were enrolled, including 74 patients with normal ALT and 54 patients with mildly elevated ALT. The total cumulative rates of viral suppression were 64.06%, 81.97% and 96.39%, at week 24, 48 and 96, respectively. The cumulative rates of viral suppression in normal and mildly elevated ALT groups were 67.86% versus 58.97%, 86.39% versus 76.31% and 93.13% versus 97.04%, at week 24, 48 and 96, respectively. The serum HBV DNA levels at week 12 and the hepatitis B surface antigen (HBsAg) levels at week 24 were significant predictors of the 96-week virological response. Compared with the values at baseline, liver stiffness values significantly decreased at week 48 (8.26 kPa vs 6.60 kPa, p < 0.001), and 96 (8.68 kPa vs 6.33 kPa, p < 0.001), respectively. Conclusions HBeAg-negative patients with normal or mildly elevated ALT could benefit from antiviral therapy with NAs. Antiviral treatment is strongly recommended for these patients.