Incidence and risk factors of progression to cirrhosis in inactive carriers of hepatitis B virus.
OBJECTIVE
Most hepatitis B virus (HBV) carriers are incidentally identified as inactive carriers (positive hepatitis B e antibody with normal alanine aminotransferase (ALT) levels), but their long-time outcome and risk of cirrhosis are incompletely understood.


METHODS
A total of 1,965 inactive carriers (mean age: 35.6 years; males: 1,076) were studied. Cirrhosis was diagnosed using a high-resolution real-time ultrasound.


RESULTS
During an 11.5-year mean follow-up, 314 carriers developed reactivation of hepatitis B (ALT was more than twice the upper limit of normal and positive HBV DNA was found using hybridization assays). The risk of reactivation of hepatitis B correlated significantly with advanced age at study entry (P<0.0001) and male sex (P<0.0001). A total of 57 patients developed cirrhosis, with the cumulative incidence being 15% after 25 years. The risk of cirrhosis correlated significantly with advanced age at entry (P=0.004) and reactivation of hepatitis B (P<0.0001). Of the 1,651 carriers without reactivation of hepatitis B, 10 developed cirrhosis, and advanced age at entry was the only significant factor (P=0.03). Of the 314 patients with reactivation of hepatitis B, cirrhosis developed in 47 of them, with the cumulative incidence being 8, 16, 27, and 46% at 5, 10, 15, and 20 years, respectively, after the onset of reactivation. Male sex (P=0.037) and advanced age at reactivation (P=0.006) were the two independent risk factors.


CONCLUSIONS
The so-called inactive carrier state cannot be generally viewed as an innocent long-lasting condition of good prognosis; regular follow-up is necessary.
Chu
Chia-Ming
CM
Liver Research Unit, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan. chiamingchu@yahoo.com.tw
Liaw
Yun-Fan
YF
D000328:Adult; D017677:Age Distribution; D000704:Analysis of Variance; D002353:Carrier State / Q000453:epidemiology*; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000150:complications* / Q000175:diagnosis / Q000235:genetics*; D006510:Hepatitis B Antibodies / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000235:genetics* / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D033162:Incidental Findings; D008103:Liver Cirrhosis / Q000453:epidemiology* / Q000235:genetics / Q000821:virology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011336:Probability; D016016:Proportional Hazards Models; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D013997:Time Factors; D014775:Virus Activation
D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens