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 20 February 2018

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News

Good long-term outcomes with seroconversion in chronic Hep B

This month's Gut investigates long-term outcome of chronic Hepatitis B in patients after 25 years.

News image

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Dr Fattovich and colleagues from Italy assessed risk factors for liver-related death.

The team re-evaluated, after a median follow-up of 25 years, a cohort of 70 Caucasian patients with Hepatitis B e antigen positive chronic hepatitis at presentation.

Follow-up studies included clinical and ultrasound examinations, biochemical and virological tests, and cause of death.

25-year survival probability was 50% with Hep B e antigen negative hepatitis
Gut

The researchers assessed 61 patients who underwent spontaneous Hepatitis B e antigen seroconversion.

The team found that during a median period of 23 years after Hepatitis B e antigen seroclearance, 66% of patients became inactive carriers.

The team observed that the remaining 34% showed alanine aminotransferase elevation.

Of these, 1% had Hepatitis B e antigen reversion, and 15% had detectable serum Hepatitis B virus DNA but were negative for Hepatitis B e antigen.

A further 13% had concurrent virus infection, and 5% had concurrent non-alcoholic fatty liver disease.

The researchers noted that liver-related death occurred in 16% of patients, caused by hepatocellular carcinoma in 5 patients and liver failure in 6 patients.

The 25-year survival probability was 40% in patients persistently Hepatitis B e antigen positive.

The team observed that the 25-year survival probability was 50% in patients with Hepatitis B e antigen negative chronic Hepatitis or reversion, and 95% in inactive carriers.

The team found that older age, male sex, cirrhosis at entry and absence of sustained remission predicted liver-related death independently.

The adjusted hazard ratio for liver related death was 33 for persistently Hepatitis B e antigen positive patients.

The team noted that the adjusted hazard ratio for liver related death was 39 for those with Hepatitis B e antigen negative chronic Hepatitis or reversion relative to inactive carriers.

Dr Fattovich's team concluded, "Most patients with Hepatitis B e antigen seroconversion became inactive carriers with very good prognosis."

"The risk of liver-related mortality in Caucasian adults with chronic Hepatitis is strongly related with sustained disease activity and ongoing high level of Hepatitis B virus replication independently of Hepatitis B e antigen status."

Gut 2008: 57(1): 84-90
03 January 2008

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