Weight Loss Normalizes ALT and Improves Long-Term Outcomes in Chronic Hepatitis B

A doctor takes measurements of an overweight patient.
A doctor takes measurements of an overweight patient.
Because after hepatitis B viral suppression the cause and intervention for elevated alanine aminotransferase is somewhat unknown, investigators conducted a real-world study.

High body mass index (BMI) is an independent risk factor for longitudinal alanine aminotransferase (ALT) elevation after complete hepatitis B virus DNA suppression; therefore, weight loss may help to normalize ALT and improve long-term outcomes, according to a study published in the Journal of Infectious Diseases.

Although the majority of patients with chronic hepatitis B achieve sustained viral control and normal ALT with long-term antiviral treatment, some patients may still present with an elevated ALT, which is often associated with unfavorable outcomes. However, little is known about the underlying cause and means of intervention for ALT elevation after complete viral suppression. Thus, researchers conducted a real-life, prospective cohort study with 1965 patients with chronic hepatitis B who achieved complete viral control by nuceleos(t)ide analogs therapy and maintained undetectable levels of hepatitis B virus DNA for at least 6 months. They found that at a median follow-up of 18.36 months, one-third of patients experienced ALT elevation, and that baseline high BMI (equal to or over 25 kg/m2), younger age, and liver cirrhosis independently increased the risk for longitudinal ALT elevation.

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At the end of follow-up, 89 (4.8%) patients reverted to a low BMI and 92 (5.0%) reverted to a high BMI. The researchers observed that compared with persistent high BMI, reversion to a low BMI reduced the risk for ALT elevation, whereas compared with persistent low BMI, onset of high BMI increased the risk for ALT elevation.

“In conclusion, ALT elevation is common in [chronic hepatitis B] patients after complete viral suppression by [nuceleos(t)ide analogs], and high BMI is an independent predictor,” stated the authors. They added: “Improvement of BMI, probably underlying reductions in steatosis, may have a beneficial effect on ALT normalization.”

Disclosure: Some study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Wang K, Lin W, Kuang Z, et al. Longitudinal change of body mass index is associated with alanine aminotransferase elevation after complete viral suppression in chronic hepatitis B patients. J Infect Dis. 2019;220:1469-1476.