Impacts of cigarette smoking on liver fibrosis and its regression under therapy in male patients with chronic hepatitis B

Abstract

Background & Aims:The role of cigarette smoking in the development of chronic hepatitis B (CHB) remains poorly understood. We assessed the potential contributions of cigarette smoking to liver fibrosis and its regression after starting antiviral therapy in CHB patients. Methods:In this cohort study, 2144 consecutive male CHB patients under no antiviral therapy were evaluated and 206 patients with significant liver fibrosis (≥F2) initiating antiviral therapy had longitudinal follow-up. Liver fibrosis was measured by liver stiffness measurement using transient elastography. To adjust for imbalances between smoking history and never smoking groups, propensity score (PS) matching model with 1:1 ratios were performed. Cigarette smoking history and intensity (packyears) were collected and documented using a standardized questionnaire.Results: Before PS matching, 432/2144 patients had advanced fibrosis in prevalence cohort. Patients with smoking history (n = 1002) had a greater prevalence of advanced fibrosis than those without (n = 1142) (24.4% vs 16.5%, P = 0.001). Multivariate logistic regression analysis demonstrated that smoking contributed to advanced fibrosis (OR, 1.458; 95% CI, 1.114-1.908). In longitudinal cohort, multivariate logistic regression analysis demonstrated retarded fibrosis regression in patients with history of smoking ≥10 pack-years (OR, 0.288; 95% CI, 0.1-0.825). After PS matching, patients with smoking history had higher prevalence of advanced fibrosis (22.8% vs 18%, P = 0.024) than those non-smokers. In post-PS-matching logistic regression, the effect of smoking on advanced fibrosis persisted (OR, 1.415; 95% CI, 1.047-1.912; P = 0.024). Conclusions: Cigarette smoking in male CHB patients aggravated liver fibrosis prior to and delayed fibrosis regression under antiviral therapy. K E Y W O R D S advanced liver fibrosis, cigarette smoking, fibrosis regression, hepatitis B virus infection | 1429 XIONG et al.

Influence of Gender and Reproductive Factors on Liver Fibrosis in Patients With Chronic Hepatitis B Infection

“…Smoking was categorized as with or without a smoking history (20). Alcohol use was categorized as with a significant drinking history (>20 g/d) or without.…”

Long-Term Changes in Hepatic Fibrosis following Hepatitis C Viral Clearance in Patients with and without HIV

“…In this cross-sectional study of patients with chronic HCV, higher consumption of tobacco measured by smoking pack-years was related to greater severity of fibrosis [15]. Further, Xiong et al [16] found that a cigarette smoking history of 10 pack years or greater was associated with advanced fibrosis in chronic hepatitis B (CHB) infection and impaired fibrosis regression with CHB treatment. The present study found that the relationship between smoking and hepatic fibrosis was also significant after HCV clearance.…”

Association between Smoking and Liver Fibrosis among Patients with Nonalcoholic Fatty Liver Disease

“…The toxic and harmful substances produced by smoking can damage the antioxidant system, including cytochrome P450 and inflammatory cytokines [33]. Although the effects of smoking on CHB infection and cirrhosis have been reported [17, 34, 35], there is limited information on the relationship between smoking and NAFLD. Hamabe et al [19] reported that smoking is an independent risk factor for NAFLD.…”

“…It can damage the antioxidant system [14, 15]. Although smoking can increase the risk for liver fibrosis and cirrhosis in patients with chronic hepatitis B (CHB) infection [16, 17], only a few studies have investigated the relationship between smoking and NAFLD. Suzuki et al [18] reported that smoking is associated with high levels of alanine aminotransferase (ALT) in patients with NAFLD.…”