T.C. Su, Y.T. Lee, T.J. Cheng, et al 286 J Formos Med Assoc 2004 • Vol 103 • No 4 CHRONIC HEPATITIS B VIRUS INFECTION AND DYSLIPIDEMIA Ta-Chen Su, 1,2 Yuan-Teh Lee, 1 Tsun-Jen Cheng, 1,2 Hsu-Ping Chien, 2 and Jung-Der Wang 1,2 1 Department of Internal Medicine, National Taiwan University Hospital, Taipei; 2 Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan. Received: 28 May 2003 Revised: 21 August 2003 Accepted: 9 December 2003 Reprint requests and correspondence to: Dr. Jung-Der Wang, Professor, Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan. Background and Purpose: The association of chronic hepatitis B virus (HBV) infection and decreased levels of high- density lipoprotein cholesterol (HDL-C) has been well documented. However, the relationship between dyslipidemia and asymptomatic chronic HBV infection is still unclear. Methods: In 1997, 1330 medical center employees (405 men and 925 women) were recruited to evaluate the effects of chronic HBV infection on serum lipid profile, including total cholesterol (TC), HDL-C, low-density lipoprotein cholesterol, and triglycerides (TG). Among these patients, 195 were found to have chronic HBV infection and 35 (17.9%) of them were found to have elevated alanine aminotransferase (ALT). Multiple linear regression analyses were used to evaluate the effects of chronic HBV infection on serum lipids. Results: The most significant finding was that levels of TC and HDL-C were decreased by 5.8 and 2.7 mg/dL respectively, among patients with asymptomatic chronic HBV infection (serum ALT < 40 U/L). After controlling for other determinants, male gender, old age, higher body mass index (BMI) and waist-to-hip ratio, current smoking, and hepatitis B surface antigen-negative status with ALT ≥ 40 U/L were associated with lower serum HDL-C and higher TG levels. However, moderate to heavy alcohol drinking, physically active lifestyle, and lower BMI were associated with higher levels of HDL-C. Conclusions: Asymptomatic chronic HBV infection was associated with lower serum levels of TC and HDL-C. Elevation of ALT was also an indicator of lower levels of HDL-C in patients with chronic hepatitis B and lower serum HDL-C and higher TG levels in patients without HBV infection. These findings also indicated the need to monitor the risk of atherosclerotic diseases in patients with asymptomatic chronic HBV infection, especially those with lower HDL-C levels. Key words: Alanine aminotransferase; Hepatitis B virus; Dyslipidemia; Lipoprotein, HDL cholesterol J Formos Med Assoc 2004;103:286-91 Hepatitis B virus (HBV) infection with its high pre- valence and associated morbidity and mortality has been recognized as an important health issue in Taiwan for more than 3 decades. 1 The hepatitis B surface anti- gen (HBsAg) infection rate in the general popula- tion is about 10 to 20% in Taiwan. 1,2 Hepatoma results in about 5800 deaths and was the leading cause of cancer death in Taiwan in 1999. 3 People with chronic HBV infection are at risk for developing sequelae, including chronic active hepatitis, 4 cirrhosis, 5 and hepatocellular carcinoma. 6 Chronic hepatitis B and C and cirrhosis of the liver have been associated with impaired lipid me- tabolism, reduced total cholesterol (TC), and reduced high-density lipoprotein cholesterol (HDL-C) in case- control studies. 7,8 Changes in serum lipids were com- monly found in patients with chronic liver disease, 7–9 and a study in China found that prolonged HBV infection was related to low blood cholesterol con- centration and increased frequency of liver cancer. 10 However, the status of serum HDL-C in patients with asymptomatic chronic HBV infection has not been reported. Furthermore, most studies about the influence of blood lipids in patients with hepatitis were conducted in small series 7–9 except for a study from China, 10 and the potential confounding factors of blood lipid levels were often overlooked, 7,8 or only partially adjusted. 9,10 We conducted this study to delineate the effects of HBV infection status and elevation of alanine aminotransferase (ALT) levels on serum lipid profile, especially their association with dyslipidemia (lower levels of HDL-C and/or higher levels of triglyceride). Methods Subjects In 1997, 1693 health workers in a medical center aged 30 to 65 years were invited to receive an annual