Liver disease

Hepatitis

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

G Fattovich¹, N Olivari¹, M Pasino¹, M D’Onofrio², E Martone², F Donato³

¹ Department of Gastroenterology, University of Verona, Verona, Italy
² Department of Radiology, University of Verona, Verona, Italy
³ Institute of Hygiene, Epidemiology and Public Health, University of Brescia, Brescia, Italy

Dr G Fattovich, Unitè Operativa di Gastroenterologia, Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Universitè di Verona, Piazzale L.A. Scuro n. 10, 37134 Verona, Italy; giovanna.fattovich{at}univr.it

Objective: To assess risk factors for liver-related death, we re-evaluated, after a median follow-up of 25 years, a cohort of 70 Caucasian patients with hepatitis B e antigen (HBeAg) positive chronic hepatitis (CH) at presentation.

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

Results: Sixty-one (87%) patients underwent spontaneous HBeAg seroconversion. During a median period of 22.8 years after HBeAg seroclearance, 40 (66%) patients became inactive carriers, whereas the remaining 21 (34%) showed alanine aminotransferase elevation: one (1%) had HBeAg reversion, nine (15%) detectable serum HBV DNA but were negative for HBeAg, eight (13%) concurrent virus(es) infection and three (5%) concurrent non-alcoholic fatty liver disease. Liver-related death occurred in 11 (15.7%) patients, caused by hepatocellular carcinoma in five and liver failure in six. The 25-year survival probability was 40% in patients persistently HBeAg positive, 50% in patients with HBeAg negative CH or HBeAg reversion and 95% in inactive carriers. Older age, male sex, cirrhosis at entry and absence of sustained remission predicted liver-related death independently. The adjusted hazard ratios (95% CI) for liver related death were 33 (3.01–363) for persistently HBeAg positive patients and 38.73 (4.65–322) for those with HBeAg negative CH or HBeAg reversion relative to inactive carriers.

Conclusion: 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.

Keywords: hepatitis B e antigen seroconversion, sustained alanine aminotransferase normalisation; inactive carrier; HBeAg negative hepatitis; sustained HBV replication

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