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Elevated alanine transaminase (ALT<\/jats:styled-content>) levels \u2265 the upper limit of normal (ULN<\/jats:styled-content>) are a major determinant for initiating anti\u2010viral therapy; however, ALT<\/jats:styled-content> levels alone may not be predictive of hepatic fibrosis.<\/jats:p><\/jats:sec>Aim<\/jats:title>To determine the proportion of CHB<\/jats:styled-content> patients with ALT<\/jats:styled-content> \u226440\u00a0IU\/L and liver fibrosis stage \u22652. Secondary goals include subgroup analysis by hepatitis B e antigen (HB<\/jats:styled-content>eAg) status, high hepatitis B virus (HBV<\/jats:styled-content>) DNA<\/jats:styled-content> levels, Asian ethnicity, lower ULN<\/jats:styled-content> of \u226430\u00a0IU\/L (males) and 19\u00a0IU\/L (females), and advanced age.<\/jats:p><\/jats:sec>Methods<\/jats:title>Studies identified in EMBASE<\/jats:styled-content> and MEDLINE<\/jats:styled-content> (1\/1990\u20136\/2012) using the search criteria: \u201cHepatitis B\u201d[Mesh] OR<\/jats:styled-content> \u201cHepatitis B virus\u201d[Mesh] OR<\/jats:styled-content> \u201cHepatitis B, Chronic\u201d[Mesh])) AND<\/jats:styled-content> \u201cAlanine Transaminase\u201d[Mesh]) and abstracts containing the term \u2018hepatitis\u2019 from recent major U.S. gastroenterology and liver society meetings were considered.<\/jats:p><\/jats:sec>Results<\/jats:title>Among nine studies (N<\/jats:italic>\u00a0=\u00a0830 patients), a significant proportion (20.7%; 95% CI: 16.2\u201326.0%) of CHB<\/jats:styled-content> patients with ALT<\/jats:styled-content> levels \u226440\u00a0IU\/L had significant fibrosis irrespective of HB<\/jats:styled-content>eAg status, high HBV DNA<\/jats:styled-content> levels, ethnicity or age, although this proportion may be higher in patients older than 30\u201340\u00a0years old. The corresponding proportion was 27.8% even when the newer ULN<\/jats:styled-content> of 30\u00a0IU\/L (males) and 19\u00a0IU\/L (females) was applied.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>Approximately one fifth of CHB<\/jats:styled-content> patients with ALT<\/jats:styled-content> \u226440\u00a0IU\/L may have significant hepatic fibrosis. The approach to such patients should be individualised, as further evaluation and treatment may be appropriate.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.12590","type":"journal-article","created":{"date-parts":[[2014,1,6]],"date-time":"2014-01-06T08:08:46Z","timestamp":1388995726000},"page":"349-358","source":"Crossref","is-referenced-by-count":96,"title":["Systematic review with meta\u2010analysis: the proportion of chronic hepatitis B patients with normal alanine transaminase \u226440\u00a0IU\/L and significant hepatic fibrosis"],"prefix":"10.1111","volume":"39","author":[{"given":"D. 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