The role of serial measurement of serum HBV DNA levels in patients with chronic HBeAg(-) hepatitis B infection: association with liver disease progression. A prospective cohort study.
OBJECTIVE
To evaluate the fluctuating course of serum HBV-DNA levels during the natural history of chronic HBV infection in the general population of North-Eastern Greece, in association with liver disease progression.


METHODS
Two hundred and sixty-three adults with chronic HBV, median 34 years of age, were randomly selected and prospectively followed-up for a maximum period of 12 years. Viral markers, liver biochemistry and physical examination were performed every 6 months, and liver biopsy/abdominal ultrasound every 2-4 years.


RESULTS
At entry, 195/263 (76%) were HBeAg (-)/anti-HBe (+) inactive carriers: (a) almost all 195 individuals with undetectable or HBV-DNA levels <2000IU/ml had no liver disease at entry and at follow-up period by imaging or liver histology evaluation (b) only 4/195 (2%) showed HBV reactivation with HBV-DNA >2000IU/ml. At entry, 48/263 (18%) patients were chronic HBeAg(-); (a) 1/3 patients had intermittently HBV-DNA <2000IU/ml for at least one occasion and were misclassified as inactive carriers (b) 22/48 (46%) had moderate/severe histology at entry and 5/48 (10%) showed liver disease progression during follow-up. Logistic regression analysis was used to derive OR (95%CI) for factors associated with liver disease progression.


CONCLUSIONS
Close monitoring of serum HBV-DNA levels is useful in the management of chronic HBeAg(-) patients, as associated with liver disease progression.
Zacharakis
George
G
Unit of Preventive Medicine, Social Security Institute, Alexandroupolis, Greece. GZacharakis@yahoo.gr
Koskinas
John
J
Kotsiou
Stamatia
S
Tzara
Fevronia
F
Vafeiadis
Nikolaos
N
Papoutselis
Menelaos
M
Maltezos
Eustratios
E
Sivridis
Eleftherios
E
Papoutselis
Kostantinos
K
D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D002353:Carrier State; D004279:DNA, Viral / Q000097:blood*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006115:Greece / Q000453:epidemiology; D006513:Hepatitis B e Antigens / Q000097:blood*; D006515:Hepatitis B virus / Q000235:genetics* / Q000302:isolation & purification; D019694:Hepatitis B, Chronic / Q000453:epidemiology / Q000473:pathology* / Q000635:transmission / Q000821:virology*; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000473:pathology / Q000821:virology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult
D004279:DNA, Viral; D006513:Hepatitis B e Antigens; D000410:Alanine Transaminase