Carriers of inactive hepatitis B virus are still at risk for hepatocellular carcinoma and liver-related death.

Abstract

BACKGROUND & AIMS:

The risk and the predictors of liver disease progression in carriers of inactive hepatitis B virus (HBV) are unclear.

METHODS:

Participants in the Risk Evaluation of Viral Load Elevation and Associated Liver Disease/Cancer-Hepatitis B Virus (REVEAL-HBV) study who were seronegative for hepatitis B e antigen; had serum levels of HBV DNA <10,000 copies/mL; and did not have cirrhosis, hepatocellular carcinoma, or increased serum levels of alanine aminotransferase were classified as carriers of inactive HBV (n = 1932). Study participants who were seronegative for HB surface antigen and antibodies against hepatitis C virus, yet had similar clinical liver features, were the controls (n = 18,137). Liver-related death and new cases of hepatocellular carcinoma were ascertained through computerized data linkage with National Cancer Registry and Death Certification profiles. The disease progression rates were estimated. The multivariate-adjusted hazard ratios for risk predictors were derived from Cox regression models.

RESULTS:

There were 20,069 participants, contributing a total of 262,122 person-years, with a mean follow-up of 13.1 years. Annual incidence rates of hepatocellular carcinoma and liver-related death were 0.06% and 0.04%, respectively, for inactive HBV carriers; rates were 0.02%, and 0.02% for controls, respectively. The multivariate-adjusted hazard ratios for carriers of inactive HBV, compared to controls, were 4.6 (95% confidence interval: 2.5-8.3) for hepatocellular carcinoma and 2.1 (95% confidence interval: 1.1-4.1) for liver-related death. Older age and alcohol drinking habits were independent predictors of risk for carriers of inactive HBV to develop hepatocellular carcinoma.

CONCLUSIONS:

Carriers of inactive HBV have a substantial risk of hepatocellular carcinoma and liver-related death compared with individuals not infected with HBV.

• Authors: Jin-De Chen, Hwai-I Yang, Uchenna H Iloeje, San-Lin You, Sheng-Nan Lu, Li-Yu Wang, Jun Su, Chien-An Sun, Yun-Fan Liaw, Chien-Jen Chen, Risk Evaluation of Viral Load Elevation and Associated Liver Disease/Cancer in HBV (REVEAL-HBV) Study Group
• Journal: Gastroenterology (Gastroenterology) Vol. 138 Issue 5 Pg. 1747-54 (May 2010) ISSN: 1528-0012 [Electronic] United States
• PMID: 20114048 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright 2010 AGA Institute. Published by Elsevier Inc. All rights reserved.

Chemical References

• DNA, Viral
• Hepatitis B Surface Antigens
• Hepatitis B e Antigens
• Hepatitis C Antibodies

Topics

• Adult
• Age Factors
• Alcohol Drinking
• Carcinoma, Hepatocellular (mortality, virology)
• Carrier State
• Case-Control Studies
• DNA, Viral (blood)
• Female
• Hepatitis B (complications, diagnosis, mortality, transmission)
• Hepatitis B Surface Antigens (blood)
• Hepatitis B e Antigens (blood)
• Hepatitis B virus (genetics, immunology, pathogenicity)
• Hepatitis C Antibodies (blood)
• Humans
• Incidence
• Liver Neoplasms (mortality, virology)
• Male
• Middle Aged
• Proportional Hazards Models
• Registries
• Risk Assessment
• Risk Factors
• Taiwan (epidemiology)
• Time Factors
• Viral Load
• Virus Inactivation