Gut 57:84-90 doi:10.1136/gut.2007.128496
  • Hepatitis
    • Liver disease

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

  1. G Fattovich1,
  2. N Olivari1,
  3. M Pasino1,
  4. M D’Onofrio2,
  5. E Martone2,
  6. F Donato3
  1. 1
    Department of Gastroenterology, University of Verona, Verona, Italy
  2. 2
    Department of Radiology, University of Verona, Verona, Italy
  3. 3
    Institute of Hygiene, Epidemiology and Public Health, University of Brescia, Brescia, Italy
  1. 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}
  • Revised 5 August 2007
  • Accepted 15 August 2007
  • Published Online First 22 August 2007


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.


  • Funding: This study was partially supported by the MURST 60% 2005 of the University of Verona (GF, 2005)

  • Competing interests: None.