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本帖最后由 StephenW 于 2012-12-6 13:59 编辑
| CONTROL ID: 1425030 |
| | PRESENTATION TYPE: Oral or Poster | | CURRENT CATEGORY: Hepatitis B | | CURRENT DESCRIPTORS: I01. Patient-centered, Natural History and Effectiveness Research | TITLE: Longterm follow-up of inactive hepatitis B virus carriers and relation with Hepatitis B surface Antigen levels
| | AUTHORS (FIRST NAME, LAST NAME): Bettina E. Hansen1, 2, Henry Lik-Yuen Chan3, Pauline Arends1, Beatrice Cherubini4, Markus Cornberg5, Alexander J. Thompson6, Yun -Fan Liaw7, Maurizia R. Brunetto4, Harry L. Janssen1 | | Institutional Author(s): for the Good Practice in using sAg in Chronic Hepatitis B Study Group (GPs-CHB Study Group) | INSTITUTIONS (ALL): 1. Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
2. Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
3. Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong , China.
4. Hepatology Unit, University of Pisa, Pisa, Italy.
5. Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
6. Victorian Infectious Diseases Reference Laboratory, North Melbourne, VIC, Australia.
7. Liver Research Unit, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan.
| ABSTRACT BODY: Introduction Patients are considered inactive HBV carriers if HBV DNA is <2000IU/mL combined with a normal ALT. Recently a single-point HBsAg<1000IU/mL has been suggested as an additional marker too accurately identify inactive carriers after 1 year of follow-up. The aim was to validate this rule for long-term follow-up of inactive carriers
Methods This investigator-initiated project studied the follow-up of untreated HBeAg negative HBV patients initially presenting with normal ALT-levels from 8 large centers (GPs-CHB Study Group).
At baseline and during follow-up patients were defined as inactive carriers (IC) (HBV DNA ≤2000IU/mL and normal ALT) or active carries (AC) (HBV DNA>2000IU/mL or abnormal ALT). Survival analyses were used to analyze the transition probability from IC to AC over time.
Results Repeated measurements of ALT, HBV DNA and quantitative HBsAg were available for 271 consecutive patients during a mean follow-up of 4.3 year. At baseline 170 patients (63%) were identified as IC and these patients were further studied. Total number of visits among IC was 1306. At baseline HBsAg was 675 IU/mL (range 0-49140) and HBV genotypes were: A 7%, B 17%, C 15%, D 44% and other 17%. Two patients had cirrhosis.
At 1 year 87% remained IC, at 2 years 75% and at 5 years 63%. HBsAg<1000IU/mL at baseline was a strong predictor for continued IC (at 1yr 89% vs 83%, 5yr 73% vs 49% in the group with <1000 vs ≥1000, p=0.001), as well as HBV DNA<200IU/mL (p<0.001). There were no differences in reactivation rates between HBV genotypes (p=0.72). HBsAg and HBV DNA were independent predictors of transition to AC (HR=1.4 by 1log increase and HR=2.5 by 1log increase). The combination of HBV DNA<100IU/mL and HBsAg<100IU/mL at baseline (n=17) gave a 100% accurate identification of IC. Overall decline of HBsAg was 0.37log in 5 years (p<0.001). Decline was not dependent on HBV DNA at baseline (p=0.83). In seven patients progression of liver disease was observed (2 HCC (1 with cirrhosis at baseline), 4 decompensation (1 with cirrhosis at baseline) and 1 non-liver related death). Five of those became AC prior to disease progression. The patient with non-liver related death remained IC until end of follow-up (7 years).
Conclusion IC with a high HBsAg at baseline are at high risk for transition to AC and further progression of liver disease. Our date suggest to revise the definition of IC in CHB patients and to include HBsAg as a marker to accurately identify IC.
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发表于 2012-12-6 13:42
