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Long-term outcome of chronic hepatitis B in caucasian patients: mortality after 25 years
  1. Giovanna Fattovich (giovanna.fattovich{at}univr.it)
  1. Department of Gastroenterology, University of Verona, Italy
    1. Nicola Olivari
    1. Department of Gastroenterology, University of Verona, Italy
      1. Michela Pasino
      1. Department of Gastroenterology, University of Verona, Italy
        1. Mirko D'Onofrio
        1. Department of Radiology, University of Verona, Italy
          1. Enrico Martone
          1. Department of Radiology, University of Verona, Italy
            1. Francesco Donato
            1. Institute of Hygiene, Epidemiology and Public Health, University of Brescia, Italy

              Abstract

              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 virologic 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: 1 (1%) had HBeAg reversion, 9 (15%) detectable serum HBV-DNA but were negative for HBeAg, 8 (13%) concurrent virus(es) infection and 3 (5%) concurrent non alcoholic fatty liver disease. Liver-related death occurred in 11 (15.7%) patients, caused by hepatocellular carcinoma in 5 and liver failure in 6. 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.

              • HBeAg negative hepatitis
              • hepatitis B e antigen seroconversion
              • inactive carrier
              • sustained HBV replication
              • sustained alanine aminotransferase normalization

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