title: Long-term outcomes of chronic hepatitis B virus infection in the era of antiviral therapy in Korea.
abstract: OBJECTIVE
  Chronic hepatitis B (CHB) can progress to cirrhosis, hepatocellular carcinoma (HCC), and ultimately liver-related deaths. Recently, owing to potent antiviral therapy with minimal side-effects, sustained suppression of hepatitis B virus replication can be achieved, thereby preventing such complications. We aimed to reappraise clinical courses regarding disease progression in the era of antiviral therapy.
  
  
  METHODS
  Between 2001 and 2005, treatment-naïve Korean CHB patients without cirrhosis were enrolled and followed up for at least 5 years. During follow up, antiviral therapy was commenced according to Korean Association for the Study of the Liver guidelines, if eligible, and ultrasonography and laboratory and clinical assessment were performed regularly. Primary end-points were development of cirrhosis, hepatic decompensation, HCC, or liver-related deaths.
  
  
  RESULTS
  Of 360 patients, 323 (89.7%) received antiviral therapy such as lamivudine (70.6%), entecavir (8.7%), or telbivudine (6.5%). During follow up, cirrhosis developed in 29 (8.1%), hepatic decompensation in 4 (1.1%), and HCC in 15 (4.2%) patients. Annual incidences of cirrhosis, hepatic decompensation, and HCC were 1.05%, 0.14%, and 0.53% per person-year, respectively. Age was an independent predictor for developing cirrhosis (hazard ratio [HR] 1.075, 95% confidence interval [CI] 1.037-1.116; P < 0.001), whereas age (HR 1.060, 95% CI 1.012-1.111; P = 0.014) and cirrhosis (HR 17.470, 95% CI 5.081-60.063; P < 0.001) were those for developing HCC.
  
  
  CONCLUSIONS
  In the era of antiviral therapy, overall clinical courses have been much improved since introduction of lamivudine in 1999. However, patients with older age or cirrhosis are still subject to HCC development despite appropriate antiviral therapy, necessitating cautious surveillance.
authors: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors: Yoon Hea
authors: YH
authors: Park
authors: Beom Kyung
authors: BK
authors: Kim
authors: Ja Kyung
authors: JK
authors: Kim
authors: Hyeon Chang
authors: HC
authors: Kim
authors: Do Young
authors: DY
authors: Kim
authors: Jun Yong
authors: JY
authors: Park
authors: Kwang-Hyub
authors: KH
authors: Han
authors: Seung Up
authors: SU
authors: Kim
authors: Seung Hwan
authors: SH
authors: Shin
authors: Kyu Yeon
authors: KY
authors: Hahn
authors: Sang Hoon
authors: SH
authors: Ahn
mesh_terms: D000328:Adult; D000367:Age Factors; D000998:Antiviral Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006147:Guanine / Q000031:analogs & derivatives / Q000627:therapeutic use; D019694:Hepatitis B, Chronic / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D008113:Liver Neoplasms / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea / Q000453:epidemiology; D000077712:Telbivudine; D013936:Thymidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D000077712:Telbivudine; D019259:Lamivudine; C413685:entecavir; D006147:Guanine; D013936:Thymidine
keywords: antiviral therapy; chronic hepatitis B; cirrhosis; decompensation; hepatocellular carcinoma; prognosis