الفهرس 
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Abstract
The prognosis and management of chronic liver diseases depend strongly on the degree of liver fibrosis. Liver biopsy (LB) examination is still the way of evaluating liver fibrosis (Marcellin et al., 2009), also, the lack of correlation of HBV DNA load and ALT level with the severity of liver damage would favor liver biopsy to be the most useful primary criterion for deciding to treat or not in the Egyptian patients (El-Zayadi, 2007). This work was done to study histopathological changes of Egyptian patients with chronic hepatitis B at initial presentation irrespective of HBV-DNA and/or ALT levels focusing on those with low viremia and/or normal ALT levels as well as evaluate the effect of antiviral therapy for chronic HBV. This study was prospectively carried on one hundred {100} patients with chronic hepatitis B selected from the outpatient clinics of Hepatology department, in National Liver Institute (NLI), Menoufiya University, from April 2010 to April 2012. Patients were classified into four equal groups according to HBV DNA and ALT levels at initial presentation: First group: 25 patients with HBV PCR ≥2000IU/ml and elevated ALT level. Second group: 25 patients with HBV PCR ≥2000IU/ml and normal ALT level. Third group: 25 patients with HBV PCR <2000IU/ml and elevated ALT level. Fourth group: 25 patients with HBV PCR <2000IU/ml and normal ALT level. Normal ranges for ALT were 30 IU/L for males and 19 IU/L for females (Keeffe et al., 2006).