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There is a paucity of data on hepatitis B virus (HBV) DNA levels and histologic lesions in patients with chronic HBV (CHBV) infection and persistently normal alanine aminotransferase (ALT) levels (PNALT). We studied the ALT, HBV DNA levels, and spectrum of histologic lesions in such patients.

One thousand three hundred eighty-seven incidentally detected asymptomatic hepatitis B surface antigen (HBsAg)-positive patients with ≥1-year follow-up and either PNALT (n = 189; hepatitis B e antigen [HBeAg⁺], 73; HBeAg⁻, 116) or persistently or intermittently elevated ALT (PIEALT; n = 1198; HBeAg⁺, 530; HBeAg⁻, 668) were included.

In the PIEALT and PNALT patients, baseline DNA ≥5-log copies/mL was seen in 73.8% and 60.3% in HBeAg⁺ (P = .018) and 76% and 35.3% in HBeAg⁻ (P < .001) patients and histologic fibrosis stage ≥2 in 65.5% and 40.2% in HBeAg⁺ (P < …