Hepatitis B (chronic): diagnosis and management

Recommendation ID: CG165/2
Question: ALT values for children and young people:- Further research should be undertaken to examine whether the upper limit of normal ALT values for adults (below 30 IU/ml for males and below 19 IU/ml for females) are appropriate for use in children and young people with chronic hepatitis B when making decisions on when to initiate treatment.
Any explanatory notes (if applicable): Why this is important:- Recent studies have highlighted the imprecision of using biochemical activity as a measure of immune activity in children and young people with chronic hepatitis B. Researchers have found T-cell exhaustion and even HBV-specific immune responses in children and young people considered to have immune-tolerant disease. These findings need to be validated in larger studies to see if upper limit of normal ALT values derived from adults accurately reflect disease activity in children and young people. Further research is needed to investigate whether there is a genuine state of immune tolerance in children and young people reflected in lower levels of biochemical activity and a lower upper limit of normal ALT value.

Source guidance details

Is this a recommendation for the use of a technology only in the context of research?	No
Is it a recommendation that suggests collection of data or the establishment of a register?	No
Last Reviewed	12/07/2013