Long-term outcome of HBV carriers with negative HBe antigen and normal aminotransferase.
OBJECTIVE
To elucidate the incidence of hepatitis activation and hepatocellular carcinogenesis in patients with negative HBe antigen and normal aminotransferase, long-term observation was performed in a retrospective cohort.


METHODS
Among 116 consecutive patients with normal aminotransferase and negative HBe antigen at the time of liver biopsy, sequential frozen sera for initial 5 years were available for 95 patients. Hepatitis B virus (HBV) DNA assay (sensitivity >400 copy/mL) and aminotransferase were annually examined in the initial 5 years after biopsy.


RESULTS
Liver biopsy showed minimal hepatitis (F0) in 9, F1 in 53, F2 in 21, F3 in 6, and F4 or cirrhosis in 6. Initial HBV DNA concentration was low (less than 10(4) copies/mL) in 33, intermediate (10(4)-10(6)) in 53, and high (10(6) or more) in 9. Hepatitis activation rates with twice as high as normal aminotransferase at the end of the third year were 12.1% in the low DNA group, 43.4% in the intermediate group, and 66.7% in the high DNA group. Initial HBV DNA values were significantly associated with future increase in aminotransferase (P <.0001). Initial DNA, history of aminotransferase elevation, and histological staging independently affected future hepatitis activation. Carcinogenesis rate in patients with and without high DNA of 10(6) copies/mL during the initial 3 years were 6.9% and 0%, respectively, at the end of the 5th year, and 11.5% and 1.8%, respectively, at the 10th year, (P=.021).


CONCLUSIONS
Advanced stages of hepatitis were sometimes found in HBe antigen-negative, aminotransferase-normal HBV carriers. Serial HBV DNA assessment in early 3 years predicted future hepatitis activation and carcinogenesis.
Ikeda
Kenji
K
Department of Hepatology, Toranomon Hospital, Tokyo, Japan. ikedakenji@tora.email.ne.jp
Arase
Yasuji
Y
Saitoh
Satoshi
S
Kobayashi
Masahiro
M
Someya
Takashi
T
Hosaka
Tetsuya
T
Sezaki
Hitomi
H
Akuta
Norio
N
Suzuki
Yoshiyuki
Y
Suzuki
Fumitaka
F
Kumada
Hiromitsu
H
D000328:Adult; D000368:Aged; D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000821:virology; D004279:DNA, Viral / Q000302:isolation & purification; D005260:Female; D006509:Hepatitis B / Q000150:complications*; D006513:Hepatitis B e Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D008113:Liver Neoplasms / Q000821:virology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D000637:Transaminases / Q000097:blood; D016896:Treatment Outcome
D004279:DNA, Viral; D006513:Hepatitis B e Antigens; D000637:Transaminases