ArticleFrontiers in cellular and infection microbiology2026
Normal ALT masks occult liver injury in young chronic hepatitis B patients: a call for early treatment intervention.
Article in Frontiers in cellular and infection microbiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Guidelines provide limited guidance on antiviral therapy for CHB patients ≤30 years with normal ALT despite occult injury risks. Methods: This multicenter cross-sectional study included 423 treatment-naïve CHB patients aged ≤30 years with persistently normal ALT who underwent liver biopsy. Significant injury was defined as METAVIR necroinflammation ≥G2 and/or fibrosis ≥S2. A non-invasive model was developed and internally validated. Results: Significant necroinflammation and fibrosis were present in 48.0% and 48.5%, respectively. Independent predictors included anti-HBc, LSM, and AST. The Y-HAL model showed excellent discrimination (AUC: 0.918), outperforming 12 existing models. A three-tier pathway stratified patients into low-risk (monitoring), high-risk (antiviral therapy), and intermediate-risk (biopsy) categories. Conclusions: A substantial proportion of young CHB patients with normal ALT have significant histological injury. The Y-HAL model and three-tier strategy offer an evidence-based framework for early intervention.
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