Anti-HBe+ and INF-a

liver411

FEBRUARY  2002

VIRAL HEPATITIS B-Outcome of Anti-HBe Positive Chronic Hepatitis B in Alpha-Interferon Treated and Untreated Patients: A Long Term Cohort Study



M.R. Brunetto (1), F. Oliveri (1), B. Coco (1), G. Leandro (2), P. Colombatto (1), J. Monti Gorin (1), F. Bonino (1)



(1) U.O. Gastroenterologia ed Epatologia, Spedali Riuniti di Santa Chiara, Pisa, Italy

(2) Ospedale `S. De Bellis' IRCCS, Castellana Grotte, Bari, Italy



Background/Aims: We studied the influence of biochemical and virologic patterns and interferon on the outcome of anti-HBe positive chronic hepatitis B in 164 (103 treated) consecutive patients, followed-up prospectively for a mean of 6 years (21 months-12 years).

Methods: Histology, biochemical and virologic profiles were characterized by monthly monitoring during the first 12 months of follow-up. Thereafter patients underwent blood and clinical controls every 4 and 6 months, respectively. Cirrhosis at follow-up histology or end stage complications of cirrhosis served as end points for the analysis of factors influencing disease progression in patients with baseline chronic hepatitis or cirrhosis, respectively.

Results: Disease progression was associated with older age (P<0.001), absence of previous HBeAg history (P=0.017) and higher serum HBV-DNA levels (P=0.009) (more frequently observed in unremitting disease profile, P=0.012) at multivariate analysis. Fluctuations of IgM anti-HBc levels (associated with disease exacerbations, P=0.045) correlated with end stage complications in cirrhotics (P=0.011). Disease improved in 14.6 and 1.6% of treated and untreated patients, respectively (P=0.015): interferon slowed disease progression (P<0.001).

Conclusions: The outcome of anti-HBe positive chronic hepatitis B is worsened by older age and persistent viral replication or hepatitis exacerbations in chronic hepatitis or in cirrhotic patients, respectively. Interferon reduces by 2.5-folds disease progression. (J. Hepatol., 36 , 263-270, 2002)