Prognostic determinants for chronic hepatitis B in Asians: therapeutic implications

Man-Fung Yuen ¹, He-Jun Yuan ¹, Danny Ka-Ho Wong ¹, John Chi-Hang Yuen ¹, Wai-Man Wong ¹, Annie On-On Chan ¹, Benjamin Chun-Yu Wong ¹, Kam-Chuen Lai ¹ and Ching-Lung Lai ^1*

¹ Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong

^* To whom correspondence should be addressed. E-mail: hrmelcl{at}hkucc.hku.hk.

Accepted 19 April 2005

Abstract

Background: Identifying risk factors for the development of complications of chronic hepatitis B (CHB) is important for setting up treatment criteria. Aim: To determine risk factors for the development of complications in Asian CHB patients.

Patients and Methods: 3,233 Chinese CHB patients (mean follow-up 46.8 months) were monitored for liver biochemistry, viral serology, HBV DNA levels, acute exacerbation, HBeAg seroconversion, and development of cirrhotic complications and hepatocellular carcinoma.

Results: The median age for HBeAg seroconversion and development of complications was 35 years and 57.2 years respectively. Patients with alanine aminotransferase (ALT) levels of 0.5 - 1 X upper limit of normal (ULN) and 1 - 2 X ULN had increased risk for the development of complications compared to patients with ALT levels < 0.5 X ULN (p<0.0001 for both). HBeAg/ anti- HBe status, and the number of episodes, duration and peak ALT levels of acute exacerbations were not associated with increased risk of complications. In patients with complications, 43.6% had the HBV DNA levels less than 1.42 X 105 copies/ml. Male gender, stigmata of chronic liver disease, old age, low albumin and high AFP levels on presentation were independently associated with increased cumulative risk of complications. Male gender, presence of hepatitis symptoms, old age, low albumin level and presence of complications on presentation were independently associated with shorter survival.

Conclusion: Prolonged low-level viremia causing insidious and continual liver damage as reflected by ALT levels of 0.5 - 2 X ULN is the most likely pathway for the development of complications in Asian CHB patients.

Keywords: HBeAg seroconversion, alanine aminotransferase, cirrhosis-related complications, hepatocellular carcinoma, survival

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