Prognosis of patients with chronic hepatitis B in France (2008-2013): A nationwide, observational and hospital-based study.
How risk factors associated with chronic hepatitis B (CHB) modify liver disease progression and mortality has been scarcely reported outside of Asia. We aimed to evaluate these risk factors in a French population between 2008 and 2013.



All individuals discharged with CHB from acute and post-acute care hospitals in Metropolitan France between January 2008 and December 2013 were selected. Associations between liver- and non-liver-related risk factors and both liver disease progression (end-stage liver disease or hepatocellular carcinoma) and mortality were assessed by multivariate Cox proportional hazard models.



Overall, liver disease progression, liver transplantation and death were recorded in 7479 (15.5%), 433 (8.2%) and 5299 (11.0%) patients, respectively. An additional liver-related risk factor was recorded in 5426 (72.6%) patients with liver disease progression and 2699 (75.5%) patients with liver transplantation or liver death. Adjusted hazard ratios (95% confidence interval) for liver disease progression of hepatitis D virus co-infection, hepatitis C virus co-infection, alcohol use disorders, diabetes mellitus, and other rare causes of chronic liver disease were 1.44 (1.35-1.53), 1.77 (1.68-1.87), 3.37 (3.20-3.55), 1.40 (1.32-1.48), and 2.19 (1.98-2.42), respectively. All liver-related risk factors increased the risk of all-cause mortality, especially after liver disease progression. Adjusted hazard ratios for liver disease progression and in-hospital mortality of HIV co-infection without acquired immune deficiency syndrome (AIDS) were 0.60 (0.52-0.70) and 0.63 (0.51-0.78), respectively.



In France, 2008-2013, liver disease progression among patients with CHB was closely related to other risk factors. HIV co-infected patients without AIDS had better outcomes, suggesting better care in this group of patients.



In France, 2008-2013, about three-quarters of patients with chronic hepatitis B who progressed to a liver-related complication, including liver transplantation and liver-related death, had an additional liver-related risk factor. Despite a higher prevalence of liver-related risk factors, HIV co-infected patients without AIDS had better outcomes. Prognosis of patients with chronic hepatitis B is closely related to other risk factors. Treatment of patients with chronic hepatitis B, including control of chronic hepatitis B-associated risk factors, is more efficient in HIV co-infected patients.
Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Institut Pasteur, Institut National de la Santé et de la Recherche Médicale (Inserm), Unité 1223, Paris, France; Hepatology Service, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Cochin Port-Royal, Paris, France. Electronic address: vincent.mallet@aphp.fr.
Vincent
V
Mallet
Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA.
Kamal
K
Hamed
Translational Health Economics Network (THEN), Paris, France; Infection Antimicrobials Modeling & Evolution (IAME), UMR 1137, Institut National de la Santé et de la Recherche Médicale (INSERM) - Université Paris Diderot, Sorbonne Paris Cité, France.
Michaël
M
Schwarzinger
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000209:etiology; D015331:Cohort Studies; D018450:Disease Progression; D058625:End Stage Liver Disease / Q000209:etiology; D005260:Female; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000401:mortality / Q000628:therapy; D006801:Humans; D008113:Liver Neoplasms / Q000209:etiology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors
Disease progression; End-stage liver disease; Epidemiology; Hepatitis B virus; Hepatocellular carcinoma; Prognosis; Risk factors