The aim of this study was to evaluate the histological outcomes of
chronic hepatitis B (CHB) patients with persistently normal
alanine aminotransferase (ALT) levels after long-term
antiviral therapy. Paired liver biopsies before and after
lamivudine (
LAM) treatment in CHB patients with normal and elevated ALT levels were compared. Histological response was defined as a 1-point decrease according to the Scheuer scoring system, without worsening of
fibrosis between pretreatment and posttreatment biopsies. Among the 48 patients who underwent paired liver biopsies, 17 had persistently normal baseline ALT level and 31 had elevated ALT level. The median age of the patients was 44 years and 72.9% of the patients were male. The median duration of
antiviral treatment was 44.5 months (range 14-104). Long-term follow-up of liver biopsies revealed that 82.4% of patients in the normal ALT group and 61.3% in the elevated ALT group had a baseline
fibrosis score of 4, which was reduced to 17.6% and 38.7% after long-term
therapy, respectively, indicating reversal of
cirrhosis in a large proportion of both groups, especially in patients with normal baseline ALT levels. Long-term
antiviral treatment could achieve significant histological improvement in CHB patients with
fibrosis or
cirrhosis, regardless of ALT level.