Long-term outcome of chronic hepatitis B in Caucasian patients: mortality after 25 years

Fattovich, Giovanna; Olivari, N; Pasino, Michela; D’Onofrio, Mirko; Martone, Enrico; Donato, Francesco

doi:10.1136/gut.2007.128496

Cited by 216 publications

(221 citation statements)

References 29 publications

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“…This is supported by natural history studies showing increased survival, lower rates of hepatic decompensation and reduction in the frequency of HCC in patients who cleared HBsAg (30)(31)(32)(33)(34)(35). In carriers with cirrhosis at HBsAg seroclearance and with no evidence of viral superinfection, liver function can improve or remain stable and hepatic decompensation rarely occurs.…”

Section: Hbsag: Clinical Relevancesupporting

confidence: 49%

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Quantification of hepatitis B surface antigen: a new concept for the management of chronic hepatitis B

Moucari

Marcellin

2011

Liver International

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HBsAg is a very important clinical test that might not only indicate active hepatitis B virus (HBV) infection but might also be used to predict clinical and treatment outcome. Clearance of HBsAg in patients with chronic HBV infection is associated with a much better clinical outcome, although surveillance for early detection of hepatocellular carcinoma (HCC) should continue. HBV DNA quantification is currently used for selecting candidates for therapy, monitoring response to therapy and detecting the emergence of drug resistance. Assays for HBsAg quantification are less expensive than HBV DNA and fully automated with a high throughput capacity. HBsAg titering may be a useful tool to manage patients with chronic HBV, to more clearly define which patients may, and more importantly, may not, benefit from treatment. Baseline and on-treatment HBsAg quantification may help to refine future treatment algorithms for both immune-modulator therapy and nucleos(t)ide analogues. Both HBV markers provide complementary information on the status of HBV infection. However, the relevance of serum HBsAg levels and its use as a reliable replacement for both covalently closed circular DNA and HBV DNA remain unclear.

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Section: Hbsag: Clinical Relevancesupporting

confidence: 49%

“…The incidence of spontaneous HBsAg seroclearance varies considerably in different series with an annual incidence of 1-2%, and does not differ much between Caucasian and Asian carriers (28)(29)(30)(31). A long-term (415 years) inactive carrier state is usually required to achieve subsequent HBsAg seroclearance.…”

Section: Hbsag: Clinical Relevancementioning

confidence: 99%

Quantification of hepatitis B surface antigen: a new concept for the management of chronic hepatitis B

Moucari

Marcellin

2011

Liver International

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“…seroconversion at [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][30][31][32][33][34][35][36][37][38][39][40], and >40 years of age, respectively. 5,6 These differences may be attributable to differences in the studied cohorts.…”

Section: Discussionmentioning

confidence: 99%

Predictors of hepatitis B e antigen‐negative hepatitis in chronic hepatitis B virus‐infected patients from childhood to adulthood

Chiu

Chang

et al. 2015

Hepatology

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Hepatitis B e antigen (HBeAg)-negative hepatitis is a clinical indicator of poor outcome for chronic hepatitis B viral (HBV) infection. This long-term prospective cohort study aimed to elucidate the predictors of developing HBeAg-negative hepatitis in chronic HBV-infected subjects followed from childhood to adulthood. We followed 434 HBeAgpositive chronic HBV-infected patients from a median age of 7.22 years (interquartile range 4.31-10.21 years). Spontaneous HBeAg seroconversion occurred in 359 subjects at a median age of 13.93 years (interquartile range 8.76-20.59 years), and 75 subjects developed HBeAg seroconversion after antiviral therapy. These patients were followed for a median of 14.40 years (interquartile range 6.14-22.02 years) after HBeAg seroconversion. Clinical data were analyzed to delineate the predictors of developing HBeAgnegative hepatitis. The HBV basal core promoter and precore/core gene sequences were also evaluated in subjects with and without HBeAg-negative hepatitis. The overall annual incidence of HBeAg-negative hepatitis was 0.37% (95% confidence internal 0.35-0.39) in spontaneous HBeAg seroconverters. The overall annual incidence of HBeAg-negative hepatitis increased to 2.64% in lamivudine-treated subjects but did not increase in those treated with interferon-alpha (0.58%). Male gender (hazard ratio 5 3.15), HBV genotype C (hazard ratio 5 4.40), HBeAg seroconversion after 18 years of age (hazard ratio 5 2.46), and lamivudine therapy prior to HBeAg seroconversion (hazard ratio 5 1.42) were predictors of HBeAg-negative hepatitis in HBeAg seroconverters (P < 0.05). HBeAg-negative hepatitis subjects carried more A1762T/G1764A, C2063A, and A2131C HBV gene mutations than those without HBeAg-negative hepatitis. Conclusions: HBeAg seroconversion during childhood predicts a lower risk of HBeAgnegative hepatitis in later life. Interferon-alpha therapy may be an effective antiviral therapy beneficial in chronic HBV-infected children with severe inflammation that facilitates HBeAg seroconversion in earlier life. (HEPATOLOGY 2016;63:74-82)

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“…HBsAg clearance is the closest to cure outcome as one can expect to achieve in hepatitis B. Support for this comes from natural history studies demonstrating increased length of survival, lower rates of hepatic decompensation, and reduction in the frequency of hepato cellular carcinoma in patients with cirrhosis who clear HBsAg [10][11][12]. Despite the added clinical importance of HBsAg clearance, this event has not been included as a primary end point in treatment trials because of the low frequency of its occurrence.…”

Section: Qualitative Hbsagmentioning

confidence: 99%

“…Unfortunately none of these surrogates can be considered an accurate and reliable clinical outcome on its own. In this respect, long-term longitudinal studies (up to 23 years) of adult inactive carriers have reported that 15-24% developed HBeAg-negative chronic hepatitis and 1-17% had sustained reversion back to HBeAg positivity [11]. It is estimated that the incidence of HBeAg-negative chronic hepatitis from inactive carriers ranges from one to three per 100 person years.…”

Section: Qualitative Hbsagmentioning

confidence: 99%

Chronic hepatitis B: back to the future with HBsAg

Moucari

Lada

Marcellin³

2009

Expert Review of Anti-infective Therapy

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Long-term outcome of chronic hepatitis B in Caucasian patients: mortality after 25 years

Abstract: Most patients with HBeAg seroconversion became inactive carriers with very good prognosis. The risk of liver-related mortality in Caucasian adults with CH is strongly related with sustained disease activity and ongoing high level of HBV replication independently of HBeAg status.

Cited by 216 publications

References 29 publications

Quantification of hepatitis B surface antigen: a new concept for the management of chronic hepatitis B

Quantification of hepatitis B surface antigen: a new concept for the management of chronic hepatitis B

Predictors of hepatitis B e antigen‐negative hepatitis in chronic hepatitis B virus‐infected patients from childhood to adulthood

Chronic hepatitis B: back to the future with HBsAg

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