Aliment Pharmacol Ther. 2018 Mar 25. doi: 10.1111/apt.14613. [Epub ahead of print]
Anti-viral therapy can be delayed or avoided in a significant proportion of HBeAg-negative Caucasian patients in the Grey Zone.
Bonacci M1, Lens S1, Mariño Z1, Londoño MC1, Rodríguez-Tajes S1, Mas A1, García-López M1, Pérez-Del-Pulgar S1, Sánchez-Tapias JM1, Forns X1.
Author information
1
Liver Unit, Hospital Clínic, CIBEREHD, IDIBAPS, University of Barcelona, Barcelona, Spain.
Abstract
BACKGROUND:
Grey Zone (GZ) is an ill-defined situation including patients falling between inactive carrier (IC) state and HBeAg-negative chronic hepatitis B (HBeAg-negative CHB).
AIMS:
We assessed the long-term outcomes of GZ patients compared to IC in the absence of treatment.
METHODS:
Retrospective analysis of 287 IC and GZ HBeAg-negative patients. Patients were classified into 4 groups at baseline: HBV-DNA <2000 IU/mL and ALT <40 U/L (IC), HBV-DNA <2000 IU/mL and ALT 40-80 U/L (GZ-1), HBV-DNA 2000-20 000 IU/mL and ALT <40 U/L (GZ-2) or ALT 40-80 U/L (GZ-3). Data were also analysed using AASLD ALT criteria.
RESULTS:
After a median follow-up of 8.2 (5-19) years, HBsAg loss occurred in about 15% ICs or GZ patients. Transition into IC state occurred in 40% of GZ patients. DNA fluctuations >2000 IU/mL correlated inversely with transition into IC and HBsAg loss. HBsAg levels were significantly lower in ICs than in GZ patients (338 IU/mL [20-3269] vs 5763 IU/mL [2172-17 754]; P < 0.05). Among the latter group, there was an increasing gradient of HBsAg levels from GZ-1 to GZ-3 patients (P < 0.05). HBeAg-negative CHB occurred in only 18 (6.3%) GZ patients. No patient developed cirrhosis nor advanced fibrosis. ALT/HBV-DNA fluctuations and HBeAg-negative CHB development were more frequent in genotype B/C patients, whereas HBsAg loss occurred only in genotype A/D patients.
CONCLUSIONS:
Most Caucasian GZ patients present excellent long-term outcomes in the absence of treatment, with a high rate of HBsAg loss and low rate of progression to HBeAg-negative CHB. HBV-genotyping and HBsAg levels could help to predict outcomes and better classify GZ patients.
回顾性分析287例IC和GZ HBeAg阴性患者。 HBV-DNA <2000 IU / mL和ALT <40 U / L（IC），HBV-DNA <2000 IU / mL和ALT 40-80 U / L（GZ-1）的患者分为4组， HBV-DNA 2000-20 000 IU / mL和ALT <40 U / L（GZ-2）或ALT 40-80 U / L（GZ-3）。数据也使用AASLD ALT标准进行分析。
结果：
中位随访8.2（5-19）年后，约15％的IC或GZ患者出现HBsAg消失。 GZ患者中有40％转变为IC状态。 DNA波动> 2000 IU / mL与IC和HBsAg消失过程呈负相关。 ICs中HBsAg水平显着低于GZ患者（338 IU / mL [20-3269] vs 5763 IU / mL [2172-17 754]; P <0.05）。在后一组中，GZ-1到GZ-3患者的HBsAg水平梯度增加（P <0.05）。仅有18例（6.3％）GZ患者发生HBeAg阴性慢性乙型肝炎。没有患者出现肝硬化，也没有进展性纤维化。基因型B / C患者ALT / HBV-DNA波动和HBeAg阴性CHB发生率更高，而HBsAg消失仅发生在基因型A / D患者中。
结论：