Abstract
The importance of alanine aminotransferase (ALT) levels in the progression of hepatitis B virus (HBV) infection remains a subject of debate. This study sought to identify independent risk factors involved in development of hepatocellular carcinoma (HCC), particularly in patients with chronic HBV infection who have normal ALT values. Data from 381 consecutive hepatitis B patients were analyzed with average ALT integration values β€40βIU/L and followβup periods of >3 years. Integration values were calculated from biochemical tests, and serological markers associated with the cumulative incidence of HCC were analyzed. HCC developed in 17 of the 381 patients (4.5%) during the followβup period. Male sex (hazard ratio, 6.011 [95% confidence interval: 1.353β26.710], Pβ=β0.018), high HBVβDNA levels (β₯5.0βlogβcopies/ml; 5.125 [1.880β13.973], Pβ=β0.001), low platelet counts (<15.0βΓ 10^4^/mm^3^; 4.803 [1.690β13.647], Pβ=β0.003), and low total cholesterol levels (<130βmg/dl; 5.983 [1.558β22.979], Pβ=β0.009) were significantly associated with greater incidence of HCC development. High HBVβDNA levels and low platelet counts are associated with the development of HCC in patients infected with hepatitis B who have normal ALT values. Therefore, maintenance of low HBVβDNA levels is important for the prevention of HCC in patients with low platelet counts, particularly in patients whose ALT values fall within the current normal range. J. Med. Virol. 82:539β545, 2010. Β© 2010 WileyβLiss, Inc.