Prognosis of Untreated Minimally Active Chronic Hepatitis B Patients in Comparison With Virological Responders by Antivirals.

Abstract

OBJECTIVES:

Serum hepatitis B virus (HBV)-DNA > 2,000 IU/mL is associated with higher risk of disease progression. However, without hepatocellular carcinoma (HCC) or cirrhosis, nucleos(t)ide analogs (NUCs) are recommended only for patients with elevated serum HBV-DNA and alanine aminotransferase ≥2 × upper normal limit.

METHODS:

We evaluated prognosis of untreated minimally active (MA) hepatitis patients (defined as HBV-DNA > 2,000 IU/mL, but never fulfilling current criteria for NUCs during follow-up) (untreated MA group), compared to virological responders by NUCs (NUC-VR group). Eligible patients undergoing transient elastography were consecutively enrolled. Patients with an immune-tolerant or inactive phase and with cirrhosis or HCC at enrollment were excluded. Cumulative risks of disease progression were assessed using the Kaplan-Meier method.

RESULTS:

The untreated MA group (n = 152) had higher HBV-DNA, alanine aminotransferase, and total bilirubin levels, and lower proportions of male and positive hepatitis B e antigen, compared to the NUC-VR group (n = 641). The untreated MA group had higher risks of HCC (adjusted hazard ratio [HR] 3.485, 95% confidence interval [CI] 1.234-9.846; P = 0.018), but similar risks of cirrhotic complications (adjusted HR 0.649, 95% CI 0.227-1.854; P = 0.420), compared to the NUC-VR group. Inverse probability of treatment weighting analysis using propensity score showed that the untreated MA group had higher risks of HCC (HR 4.464, 95% CI 2.008-9.901; P < 0.001), but similar risks of cirrhotic complications (HR 1.171, 95% CI 0.594-2.309; P = 0.649), compared to the NUC-VR group.

DISCUSSION:

Through appropriate adjustment of potential prognostic factors, the untreated MA group consistently showed higher risks of HCC, but similar risks of cirrhotic complications, compared to the NUC-VR group. HCC risk might be reduced through earlier NUCs for the untreated MA group.

• Authors: Hye Won Lee, Seung Up Kim, Jun Yong Park, Oidov Baatarkhuu, Do Young Kim, Sang Hoon Ahn, Kwang-Hyub Han, Beom Kyung Kim
• Journal: Clinical and translational gastroenterology (Clin Transl Gastroenterol) Vol. 10 Issue 6 Pg. e00036 (06 2019) ISSN: 2155-384X [Electronic] United States
• PMID: 31107725 (Publication Type: Journal Article)

Chemical References

• Antiviral Agents
• DNA, Viral
• Hepatitis B e Antigens
• Nucleosides

Topics

• Adult
• Antiviral Agents (therapeutic use)
• Carcinoma, Hepatocellular (epidemiology, prevention & control, virology)
• DNA, Viral (blood)
• Disease Progression
• Female
• Hepatitis B e Antigens (blood)
• Hepatitis B, Chronic (complications, drug therapy)
• Humans
• Kaplan-Meier Estimate
• Liver Cirrhosis (epidemiology, prevention & control, virology)
• Liver Neoplasms (epidemiology, prevention & control, virology)
• Male
• Middle Aged
• Nucleosides (analogs & derivatives, therapeutic use)
• Propensity Score
• Proportional Hazards Models
• Republic of Korea
• Risk Assessment
• Risk Factors
• Sustained Virologic Response
• Viral Load