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Abstract Details
medLow Incidence of Adverse Outcomes in Adults with Chronic Hepatitis B Virus Infection in the Era of Antiviral Therapy
Hepatology. 2020 Sep 16.doi: 10.1002/hep.31554. Online ahead of print.
Anna S Lok1, Robert Perrillo2, Christina M Lalama3, Michael W Fried4, Steven H Belle5, Marc G Ghany6, Mandana Khalili7, Robert J Fontana1, Richard K Sterling8, Norah Terrault9, Jordan J Feld10, Adrian M Di Bisceglie11, Daryl T Y Lau12, Mohamed Hassan13, Harry L A Janssen14, Hepatitis B Research Network (HBRN)
Collaborators
Hepatitis B Research Network (HBRN):
Raymond T Chung, Lewis R Roberts, Mauricio Lisker-Melman, David K Wong, Joshua Juan, Colina Yim, Keyur Patel, William M Lee, Carol S Murakami, Son Do, Steven-Huy B Han, Tram T Tran, Stewart L Cooper, Naoky Tsai, Barak Younoszai, Andrew Muir, Donna Evon, Jama M Darling, Robert C Carithers, Kris V Kowdley, Chia C Wang, Velimir A Luketic, T Jake Liang, Jay H Hoofnagle, Edward Doo, Kyong-Mi Chang, Jang-June Park, Abdus Wahed, Wendy C King, David Kleiner
Author information
1Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA.
2Hepatology Division, Baylor Scott and White Medical Center, Dallas, Texas, USA.
3Statistical Data Analyst, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
4UNC Liver Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
5Epidemiology and Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
6Liver Diseases Branch, NIDDK, NIH, Bethesda, MD, USA.
7Department of Medicine, Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, CA, USA.
8Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University, Richmond, VA, USA.
9Division of Gastrointestinal and Liver Diseases, Keck Medicine of University of Southern California, Los Angeles, CA, USA.
10Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Canada.
11Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA.
12Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
13Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolois, MN, USA.
14Toronto Centre for Liver Disease, University of Toronto, Toronto, Canada.
Abstract
Background and aims: Outcomes of persons with chronic HBV infection in the era of antiviral therapy are not well characterized. We determined the incidence and factors associated with clinical outcomes in a multiethnic, North American cohort of adults with chronic HBV infection, who were not on antiviral therapy at enrollment.
Methods: Adults with chronic HBV infection, not receiving antiviral therapy, and without a history of decompensation, HCC or OLT were prospectively followed. Participants with known HIV, HCV or HDV coinfection were excluded. During follow-up, treatment could be initiated per standard of care. Clinical outcomes included: incident cirrhosis, decompensation, HCC, OLT and HBV-related death.
Results: Among 1418 participants analyzed, 51.5% were women, median age 41.1 years, 75% Asian, 10% white, 13% black, 24% HBeAg(+), and 1.5% cirrhosis at baseline. During the study, 274 started treatment, 83 had an ALT flare, 118/330 initially HBeAg(+) became HBeAg(-), and 90/1329 became HBsAg(-). After 6641 person-years follow-up, 8 participants (4/21 with baseline cirrhosis) had 12 clinical outcomes (2 decompensation, 5 HCC, 2 OLT, 3 HBV-related deaths) and 19/1397 had incident cirrhosis. 21/26 participants had first outcome before treatment, none had become HBsAg(-) while 5/9 HBeAg(+) had become HBeAg(-) at time of first outcome. Cumulative percentage of clinical outcomes was 16% at year 4 in participants with baseline cirrhosis, and 2% (including incident cirrhosis) at year 7 in those without.
Conclusions: Incidence of adverse outcomes was low in this closely monitored large cohort of North American adults with predominantly inactive, non-cirrhotic chronic HBV. Our data highlight the benefits of HBsAg loss and the importance of early diagnosis and treatment to prevent cirrhosis and other complications of chronic HBV infection.