THU-219
Long-term outcome in Caucasian patients with hepatitis B e
antigen-negative chronic infection: An observational cohort
study
Özgür Koc1,2,3, Geert Robaeys1,2,4, Rob Bielen1,2, Dana Busschots1,2,
Ger Koek3,5, Frederik Nevens4. 1Ziekenhuis Oost-Limburg, Genk,
Belgium; 2Hasselt University, Hasselt, Belgium; 3Maastricht University
Medical Centre, Maastricht, Netherlands; 4University Hospitals
KULeuven, Leuven, Belgium; 5University Hospital of the RWTH, Aachen,
Germany
Email: [email protected]
Background and aims: The long-term outcome and risk of hepatitis
B virus (HBV) reactivation in the Caucasian population with hepatitis
B e antigen (HBeAg)-negative chronic infection have rarely been
studied before. In this study, we explored this issue by a long-term
follow-up of patients with HBeAg-negative chronic infection.
Method: Out of 1, 081 patients with chronic HBV infection,
we retrospectively identified 236 Caucasian patients with HBeAgnegative
chronic infection who presented at the Outpatient
Hepatology Department of University Hospitals KULeuven between
1 January 1968 and 31 July 2018. HBeAg-negative chronic infection
was defined as low or undetectable HBV DNA (≤20, 000 IU/ml) and
persistently normal alanine-aminotransferase levels (PNALT).
Patients previously treated with HBV antiviral agents or corticosteroids
were to be excluded as well as patients with cirrhosis at
presentation and patients with co-existing chronic liver disease.
Figure 1: Cumulative probability of reactivation of hepatitis B in Caucasian
patients with hepatitis B e antigen-negative chronic infection.
Results: During a median follow-up of 10 (interquartile range: 14.2)
years, 208 (88%) of the 236 patients showed sustained remission,
whereas the remaining 28 (12%) experienced reactivation of hepatitis
B. The cumulative probabilities of reactivation of hepatitis B were 2%, 8% and 27% at 5, 10 and 20 years follow-up, respectively (Fig. 1). In a
multivariate analysis using Cox proportional hazards regression
models, reactivation of hepatitis B was independently associated
with advanced age at presentation (>40 years) (hazard ratio (HR) =
2.92; 95% confidence interval (CI) = 1.23-6.92; p = .015) and any HBV
DNA level >2, 000 IU/ml (HR = 3.68; 95% CI = 1.53-8.82; p = .004).
Significant fibrosis (liver stiffness >9 kPa) and cirrhosis developed in
respectively 9/133 (7%) and 3/236 (1%) patients. Cox proportional
hazard regression models showed that advanced age at presentation
was the only factor significantly associated with a higher risk of
significant fibrosis (HR = 4.90; 95% CI = 1.71-14.1; p = .003).
Conclusion: Antiviral treatment is not indicated in Caucasian
patients with HBeAg-negative chronic infection since the prognosis
of liver disease is favourable. However, the results from this study
reinforce the need for clinical surveillance for the risk of HBV
reactivation in patients older than 40 years and those with any HBV
DNA level >2, 000 IU. 作者: StephenW 时间: 2019-4-4 13:14