title: Long-term follow-up of HBsAg-positive patients in Germany.
abstract: BACKGROUND
  Little is known about the prognosis and complications of chronic hepatitis B in countries with low disease prevalence including Germany.
  
  
  METHODS
  This retrospective/prospective study analyzes the course of 608 HBsAg-positive patients between 2002 and 2012 in Germany. The follow-up duration was 5.2±2.9 years (mean±SD) and the age of the patients was 40.4±13.8 years. Of the total cohort, 59.9% were men; 34.9% had been born in Germany, 30.4% in Turkey, and 34.7% in other countries.
  
  
  RESULTS
  In 78.3% of women, diagnosis was made during pregnancy screening, which is the only reinforced screening procedure in Germany. During follow-up, 21 patients died, five had a LTX, and 20 developed a hepatocellular carcinoma. Of the total cohort, 15% developed at least one severe liver-associated complication. By multivariate analysis, prognosis was associated with high age and cirrhosis, but not with sex, HBV-DNA, alanine aminotransferase, and ethnic origin. Of the 608 patients, 211 (34.7%) had at least one antiviral therapy. Of the 178 patients who were treated with nucleot(s)ides at the last visit 88.8% had an HBV-DNA less than 20 IU/ml.
  
  
  CONCLUSIONS
  Today, in Germany, hepatitis B is a disease of migrants. The present data show that mandatory screening is effective and needs to include more high-risk groups. Mortality and complications including hepatocellular carcinoma are associated primarily with cirrhosis and age, but not with HBeAg status or viral load probably because modern therapies considerably reduce viral replication in almost all patients. The prognosis is exclusively determined by the risk for hepatocellular carcinoma.
authors.affiliation: aDepartment of Internal Medicine, Katholisches Klinikum Oberhausen, St Josef Hospital, Academic Teaching Hospital of the University Duisburg-Essen, Oberhausen bInstitute for Pathology at Evangelisches Krankenhaus Bethesda Duisburg, Academic Teaching Hospital of the Heinrich-Heine University, Düsseldorf, Germany.
authors.forename: Claus
authors.initials: C
authors.lastname: Niederau
authors.forename: Asef
authors.initials: A
authors.lastname: Amani
authors.forename: Andreas
authors.initials: A
authors.lastname: Thiel
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000328:Adult; D000367:Age Factors; D000998:Antiviral Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000821:virology*; D004279:DNA, Viral / Q000097:blood*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006147:Guanine / Q000031:analogs & derivatives / Q000627:therapeutic use; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D019694:Hepatitis B, Chronic / Q000097:blood* / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000821:virology; D008113:Liver Neoplasms / Q000821:virology*; D016031:Liver Transplantation / Q000706:statistics & numerical data; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D063065:Organophosphonates / Q000627:therapeutic use; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D000077712:Telbivudine; D000068698:Tenofovir / Q000627:therapeutic use; D013936:Thymidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D013997:Time Factors; D014421:Turkey / Q000208:ethnology
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D063065:Organophosphonates; D000077712:Telbivudine; D019259:Lamivudine; C413685:entecavir; D006147:Guanine; C053001:adefovir; D000068698:Tenofovir; D000225:Adenine; D013936:Thymidine