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Dr. Deepak Anand R.
Dr. Sabariselvan C.


Chronic Hepatitis B Virus, Infected Patients ('e' negative), Viral Load, Normal or Borderline AST/ALT Elevation


Background: This study was conducted to examine patients who were chronically infected with the hepatitis B virus ('e' negative), with a viral load of around 10,000 copies/ml and normal to borderline elevated AST/ALT levels.

Methods: 43 chronic HBV-infected patients at Southern Railway Headquarters Hospital, Aynavaram, Chennai, participated in this hospital-based cross-sectional study from June 2011 to May 2013, with written informed consent from study participants and approval from the institutional ethics committee.

Results: When performing a correlation analysis, at the 0.05 level (2-tailed), the correlation is significant; at the 0.01 level (2-tailed), the correlation is significant. The minimum observed test value minus one is the smallest cut-off value in the ROC curve (PCR coordinates), while the maximum observed test value plus one is the greatest cut-off value. The remaining cut-off values are the averages of two consecutively ordered observed test values. There is at least one tie between the positive actual state group and the negative actual state group in the ROC curve's alt coordinates. a. The greatest observed test value plus one is the biggest cut-off value; the smallest cut-off value is the least observed test value minus one. The averages of two consecutively ordered observed test values are used to determine all other cut-off values. The test result variable(s): ALT has at least one tie between the positive actual state group and the negative actual state group in the area under the ROC curve comparison between alt and PCR. There could be bias in the statistics. a) Assuming nonparametric data; b) True area = 0.5 is the null hypothesis.

Conclusion: In order to distinguish between inactive carriers and e-negative chronic HBV infection, liver biopsy is essential in patients with normal AST/ALT and HBV DNA levels of approximately 105 copies/ml. Since ALT seems to have a stronger correlation with necro-inflammatory activity, periodic monitoring of it is essential.

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