title: Impact of comorbidities on the severity of chronic hepatitis B at presentation.
abstract: OBJECTIVE
  To evaluate the clinical relevance of each cofactor on clinical presentation of chronic hepatitis B.
  
  
  METHODS
  Out of 1366 hepatitis B surface antigen (HBsAg) positive subjects consecutively observed in 79 Italian hospitals, 53 (4.3%) showed as the only cofactor hepatitis D virus (HDV) infection [hepatitis B virus (HBV)/HDV group], 130 (9.5%) hepatitis C virus (HCV) (group HBV/HCV), 6 (0.4%) human immunodeficiency virus (HIV) (group HBV/HIV), 138 (10.2%) alcohol abuse (group HBV/alcohol); 109 (8.0%) subjects had at least two cofactors and 924 were in the cofactor-free (CF) group.
  
  
  RESULTS
  Compared with patients in group CF those in group HBV/alcohol were older and more frequently had cirrhosis (P < 0.001), those in group HBV/HDV were younger (P < 0.001), more frequently resided in the south of the country and had cirrhosis (P <0.001), those in group HBV/HCV were older (P < 0.001) and more frequently had cirrhosis (P < 0.001). These cofactors were all independent predictors of liver cirrhosis in HBsAg positive patients. Multivariate analysis showed that an older age [odds ratio (OR) 1.06, 95% CI: 1.05-1.08], alcohol abuse with more than 8 drinks daily (OR 2.89, 95% CI: 1.81-4.62) and anti-HDV positivity (OR 3.48, 95% CI: 2.16-5.58) are all independently associated with liver cirrhosis. This association was found also for anti-HCV positivity in univariate analysis, but it was no longer associated (OR 1.23, 95% CI: 0.84-1.80) at multivariate analysis.
  
  
  CONCLUSIONS
  Older age, HDV infection and alcohol abuse are the major determinants of severe liver disease in chronic HBV infection, while HCV replication plays a lesser role in the severity of hepatic damage.
authors.affiliation: Department of Public Medicine, Section of Infectious Diseases, Second University of Naples, 80132 Naples, Italy. evangelista.sagnelli@unina2.it
authors.forename: Evangelista
authors.initials: E
authors.lastname: Sagnelli
authors.forename: Tommaso
authors.initials: T
authors.lastname: Stroffolini
authors.forename: Alfonso
authors.initials: A
authors.lastname: Mele
authors.forename: Michele
authors.initials: M
authors.lastname: Imparato
authors.forename: Caterina
authors.initials: C
authors.lastname: Sagnelli
authors.forename: Nicola
authors.initials: N
authors.lastname: Coppola
authors.forename: Piero Luigi
authors.initials: PL
authors.lastname: Almasio
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000437:Alcoholism / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D019694:Hepatitis B, Chronic / Q000453:epidemiology*; D006526:Hepatitis C / Q000453:epidemiology*; D003699:Hepatitis D / Q000453:epidemiology*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008103:Liver Cirrhosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index