Prognostic determinants for chronic hepatitis B in Asians: therapeutic implications.
BACKGROUND
Identifying risk factors for the development of complications of chronic hepatitis B (CHB) is important for setting up treatment criteria.


OBJECTIVE
To determine risk factors for the development of complications in Asian CHB patients.


METHODS
A total of 3233 Chinese CHB patients (mean follow up 46.8 months) were monitored for liver biochemistry, viral serology, hepatitis B virus (HBV) DNA levels, acute exacerbation, hepatitis B e antigen (HBeAg) seroconversion, and development of cirrhotic complications and hepatocellular carcinoma.


RESULTS
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 times the upper limit of normal (ULN) and 1-2x ULN had an increased risk for the development of complications compared with patients with ALT levels <0.5x ULN (p<0.0001 for both). HBeAg/antibody to hepatitis B e antigen status, and number of episodes, duration, and peak ALT levels of acute exacerbations were not associated with an increased risk of complications. In patients with complications, 43.6% had HBV DNA levels less than 1.42x10(5) copies/ml. Male sex, stigmata of chronic liver disease, old age, low albumin, and high alpha fetoprotein levels on presentation were independently associated with increased cumulative risk of complications. Male sex, presence of hepatitis symptoms, old age, low albumin level, and presence of complications on presentation were independently associated with shorter survival.


CONCLUSIONS
Prolonged low level viraemia causing insidious and continual liver damage, as reflected by ALT levels of 0.5-2x ULN, is the most likely pathway for the development of complications in Asian CHB patients.
Yuen
M-F
MF
Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam Rd, Hong Kong, China.
Yuan
H-J
HJ
Wong
D K-H
DK
Yuen
J C-H
JC
Wong
W-M
WM
Chan
A O-O
AO
Wong
B C-Y
BC
Lai
K-C
KC
Lai
C-L
CL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood; D044466:Asian People; D015415:Biomarkers / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000821:virology; D002648:Child; D002675:Child, Preschool; D004279:DNA, Viral / Q000097:blood; D018450:Disease Progression; D005260:Female; D006513:Hepatitis B e Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000302:isolation & purification; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000208:ethnology / Q000628:therapy; D006723:Hong Kong; D006801:Humans; D007223:Infant; D008103:Liver Cirrhosis / Q000821:virology; D008113:Liver Neoplasms / Q000821:virology; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis; D014766:Viremia / Q000150:complications
D015415:Biomarkers; D004279:DNA, Viral; D006513:Hepatitis B e Antigens; D000410:Alanine Transaminase