RELATION BETWEEN LABORATORY TEST-RESULTS AND HISTOLOGICAL HEPATITIS ACTIVITY IN INDIVIDUALS POSITIVE FOR HEPATITIS-B SURFACE-ANTIGEN AND ANTIBODIES TO HEPATITIS-B E-ANTIGEN

Background Hepatitis B surface antigen (HBsAg) and antibodies to hepat itis B e antigen (anti-HBe) commonly coexist, and laboratory tests are often requested to assess histological hepatitis activity. An optimum panel of tests has not been found and the usefulness of hepatitis B v irus (HBV) DNA assays in this context has not been established. We ass essed various blood tests to find which best predicted hepatitis activ ity. Methods Routine plasma biochemical liver tests and serum HBV DNA (hybridisation and PCR assays) were assessed prospectively in 123 pati ents positive for HBsAg and anti-HBe. We scored histological hepatitis activity (hepatitis activity index) and determined whether chronic ac tive hepatitis (chronic hepatitis with portal and periportal lesions) was present. We analysed the relation between laboratory data and the hepatitis activity index or risk of chronic active hepatitis by multip le regression and multiple logistic regression, respectively.Findings The analyses provided models for predicting either the hepatitis activ ity index or the risk of chronic active hepatitis. Aspartate aminotran sferase was the most important test in the two models. The contributio n of HBV DNA and other assays, especially alanine-aminotransferase act ivity, were of no practical importance. Interpretation Because screeni ng by aspartate-aminotransferase activity could not be improved by the addition of other assays or HBV DNA, patients positive for HBsAg and anti-HBe could be screened for chronic active hepatitis with a single assay and counselling of patients can be improved if proper reference values are used.