抗病毒治疗时代成人慢性乙型肝炎病毒感染不良结果发生率

StephenW

medLow Incidence of Adverse Outcomes in Adults with Chronic Hepatitis B Virus Infection in the Era of Antiviral Therapy
Anna S. Lok
Robert Perrillo
Christina M. Lalama
Michael W. Fried
Steven H. Belle
Marc G. Ghany
Mandana Khalili
Robert J. Fontana
Richard K. Sterling
Norah Terrault
… See all authors
First published: 16 September 2020
https://doi.org/10.1002/hep.31554

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1002/hep.31554
PDFPDF
Tools
Share
Abstract
Background and Aims

Outcomes of persons with chronic HBV infection in the era of antiviral therapy are not well characterized. We determined the incidence and factors associated with clinical outcomes in a multiethnic, North American cohort of adults with chronic HBV infection, who were not on antiviral therapy at enrollment.
Methods

Adults with chronic HBV infection, not receiving antiviral therapy, and without a history of decompensation, HCC or OLT were prospectively followed. Participants with known HIV, HCV or HDV coinfection were excluded. During follow‐up, treatment could be initiated per standard of care. Clinical outcomes included: incident cirrhosis, decompensation, HCC, OLT and HBV‐related death.
Results

Among 1418 participants analyzed, 51.5% were women, median age 41.1 years, 75% Asian, 10% white, 13% black, 24% HBeAg(+), and 1.5% cirrhosis at baseline. During the study, 274 started treatment, 83 had an ALT flare, 118/330 initially HBeAg(+) became HBeAg(‐), and 90/1329 became HBsAg(‐). After 6641 person‐years follow‐up, 8 participants (4/21 with baseline cirrhosis) had 12 clinical outcomes (2 decompensation, 5 HCC, 2 OLT, 3 HBV‐related deaths) and 19/1397 had incident cirrhosis. 21/26 participants had first outcome before treatment, none had become HBsAg(‐) while 5/9 HBeAg(+) had become HBeAg(‐) at time of first outcome. Cumulative percentage of clinical outcomes was 16% at year 4 in participants with baseline cirrhosis, and 2% (including incident cirrhosis) at year 7 in those without.
Conclusions

Incidence of adverse outcomes was low in this closely monitored large cohort of North American adults with predominantly inactive, non‐cirrhotic chronic HBV. Our data highlight the benefits of HBsAg loss and the importance of early diagnosis and treatment to prevent cirrhosis and other complications of chronic HBV infection.

StephenW

抗病毒治疗时代成人慢性乙型肝炎病毒感染不良结果发生率低
安娜·乐
罗伯特·佩里略
克里斯蒂娜·M·拉拉马
迈克尔·W·弗里德
史蒂芬·H·贝尔
马克·加尼
曼达娜·哈利利（Mandana Khalili）
罗伯特·丰塔纳
理查德·斯特林
诺拉·泰拉特（Norah Terrault）
…查看所有作者
首次发布：2020年9月16日
https://doi.org/10.1002/hep.31554

本文已被接受发表，并且经过了完整的同行评审，但尚未经过复制编辑，排版，分页和校对过程，因此可能会导致此版本与“记录版本”之间的差异。请引用本文作为doi：10.1002 / hep.31554
PDF格式
工具类
分享
抽象
背景和目标

在抗病毒治疗时代，慢性HBV感染者的治疗效果尚不明确。我们确定了在北美多种族慢性HBV感染成年人中的发病率和与临床结局相关的因素，这些成年人在入组时未接受抗病毒治疗。
方法

预期随访患有慢性HBV感染，未接受抗病毒治疗，无失代偿史，HCC或OLT的成年人。已知HIV，HCV或HDV合并感染的参与者被排除在外。在随访期间，可以按照护理标准开始治疗。临床结果包括：肝硬化，代偿失调，HCC，OLT和HBV相关死亡。
结果

在分析的1418名参与者中，基线时女性为51.5％，中位年龄为41.1岁，亚洲为75％，白人为10％，黑人为13％，HBeAg（+）为24％，肝硬化为1.5％。在研究过程中，有274例开始治疗，有83例患有ALT发作，最初的HBeAg（+）变为HBeAg（-），有118/330，而90/1329变为HBsAg（-）。经过6641人年的随访，有8名参与者（基线肝硬化为4/21）有12项临床结局（失代偿2例，5例HCC，2 OLT，3例HBV相关死亡）和19/1397发生了肝硬化。 21/26的参与者在治疗前有第一个结果，在第一个结果发生时，没有人变成HBsAg（-），而5/9 HBeAg（+）变成了HBeAg（-）。基线肝硬化患者在第4年的临床结局累计百分比为16％，而没有基线肝硬化的患者在第7年的临床结局累积百分比为2％（包括突发性肝硬化）。
结论

在这一密切监测的北美成年人中，非活动性，非肝硬化性慢性HBV不良人群的不良结局发生率较低。我们的数据强调了HBsAg丢失的益处以及早期诊断和治疗对预防肝硬化和慢性HBV感染的其他并发症的重要性。