A long-term study of liver-related events in Caucasian hepatitis B patients with normal ALT values and high viremia
Ö M Koc 1 2 , J Verbeek 3 , G H Koek 4 5 , R Bielen 1 6 , D Busschots 1 6 , M Gamil 3 , G Robaeys 1 6 3 , F Nevens 3
Affiliations
Affiliations
1
Faculty of Health and Life Sciences, Hasselt University, Diepenbeek, Belgium.
2
Department of Medical Microbiology, School of NUTRIM, Maastricht University Medical Centre+, Maastricht, the Netherlands.
3
Department of Gastroenterology and Hepatology, KU Leuven University Hospitals, Leuven, Belgium.
4
Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, the Netherlands.
5
Department of Surgery, University Hospital Aachen, Aachen, Germany.
6
Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium.
PMID: 35304994 DOI: 10.51821/85.1.9160
Abstract
Background and study aims: There is ongoing debate whether antiviral therapy should be initiated in hepatitis B e antigen (HBeAg)-negative patients with normal alanine aminotransferase (ALT) levels but high HBV DNA levels >2,000 IU/mL. Since the need for antiviral therapy might be different between Asian and Caucasian patients, we studied the long-term disease outcome in Caucasian patients living in Western Europe.
Patients and methods: One hundred sixteen patients with high HBV DNA levels (>2,000 IU/mL) at diagnosis were included in the high viremia group, while those with HBV DNA <2,000 IU/mL were used as controls (n = 327). All patients were Caucasian, HBeAg negative, had normal ALT levels and had no significant liver disease at diagnosis.
Results: Median follow-up was 7 + 9.8 years in the high viremia group and this was 10 + 12.5 years in controls. The cumulative probability of a liver-related event over 10 years was 4.8% vs 0.0% in the control group (p=.008). In multivariable analysis, high viremia group was associated with the occurrence of a liver-related event (hazards ratio (HR) 95% confidence interval (CI): 1.20-11.98, p=.023). In this subgroup, older age at diagnosis (HR 95% CI: 1.01-1.16, p=.023) predicted a higher risk of liver-related event. In the high viremia group, liver-related mortality was 0.9% and none of the patients developed hepatocellular carcinoma.
Conclusions: HBV DNA >2,000 IU/mL influences the long-term disease outcome in Caucasian HBeAg-negative patients living in Western Europe. Nevertheless, the risk of liver-related events is low.