J Med Virol. 2020 Apr 28. doi: 10.1002/jmv.25950. [Epub ahead of print]
Outcome in Caucasian patients with hepatitis B e antigen negative chronic infection: a long-term observational cohort study.
Koc ÖM1,2,3,4, Robaeys G1,2,5, Topal H6, Bielen R1,2, Busschots D1,2, Fevery J5, Koek GH4,7,8, Nevens F5.
Author information
1
Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium.
2
Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.
3
Department of Medical Microbiology, Maastricht University Medical Centre, Maastricht, the Netherlands.
4
School of Nutrition and Translational Research in Metabolism (NUTRIM), University Maastricht, Maastricht, the Netherlands.
5
Department of Gastroenterology and Hepatology, University Hospitals KULeuven, Leuven, Belgium.
6
Department of Abdominal Surgery, University Hospitals KU Leuven, Leuven, Belgium.
7
Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, the Netherlands.
8
Department of visceral surgery and transplantation, University Hospital of the RWTH, Aachen, Germany.
Abstract
BACKGROUND & AIMS:
Sensitive PCR assays to measure HBV DNA became only available the last decade. Hence, the long-term outcome of Caucasian patients in Western Europe with hepatitis B e antigen (HBeAg)-negative chronic infection, especially with a baseline HBV DNA level > 2,000 IU/mL, is still unclear.
METHODS:
Out of a cohort of 1,936 chronic HBV patients, 413 Caucasian individuals were identified with HBeAg-negative chronic infection, defined as persistently normal alanine aminotransferase (ALT) levels and HBV DNA levels < 20,000 IU/mL.
RESULTS:
During a mean follow-up of 12 years, 366 (88.6%) maintained a HBeAg-negative chronic infection status, whereas 25 (6.1%) developed chronic active hepatitis (CAH). Nine of these 25 CAH cases were related to immunosuppression. Twenty-two (5.3%) individuals had ALT > 2 x ULN due to non-HBV related causes. The cumulative probability of spontaneously developing CAH after 10 years was almost exclusively seen in patients with baseline HBV DNA level > 2,000 IU/mL (11.7% vs 1.2%, p < 0.001). Advanced liver disease developed significantly more in patients with baseline HBV DNA level > 2,000 IU/mL (5.2% vs 1.5%, p = 0.018) and occurred especially in patients with obesity (16.7% vs 4.2% p = 0.049). The incidence of hepatocellular carcinoma was 0.0%.
CONCLUSIONS:
Caucasian patients with HBeAg-negative chronic infection and baseline HBV DNA level of < 2,000 IU/mL have an excellent long-term prognosis in the absence of immunosuppressive therapy. However, patients with baseline HBV DNA level > 2,000 IU/mL are at risk to develop advanced liver disease. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
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