High risk of hepatocellular carcinoma and death in patients with immune-tolerant-phase chronic hepatitis B
- Authors
- Kim, Gi-Ae; Lim, Young-Suk; Han, Seungbong; Choi, Jonggi; Shim, Ju Hyun; Kim, Kang Mo; Lee, Han Chu; Lee, Yung Sang
- Issue Date
- May-2018
- Publisher
- BMJ PUBLISHING GROUP
- Keywords
- antiviral therapy; chronic viral hepatitis; hepatitis B; hepatocellular carcinoma; liver transplantation
- Citation
- GUT, v.67, no.5, pp.945 - 952
- Journal Title
- GUT
- Volume
- 67
- Number
- 5
- Start Page
- 945
- End Page
- 952
- URI
- https://scholarworks.bwise.kr/gachon/handle/2020.sw.gachon/3782
- DOI
- 10.1136/gutjnl-2017-314904
- ISSN
- 0017-5749
- Abstract
- Objective High serum HBV DNA levels are associated with high risks of hepatocellular carcinoma (HCC) and cirrhosis in patients with chronic hepatitis B (CHB). Although the immune-tolerant (IT) phase is characterised by high circulating HBV DNA levels, it remains unknown whether antiviral treatment reduces risks of HCC and mortality. Design This historical cohort study included HBeAg-(p)ositive patients with CHB with high HBV DNA levels (>= 20 000 IU/mL) and no evidence of cirrhosis at a tertiary referral hospital in Korea from 2000 to 2013. The clinical outcomes of 413 untreated IT-phase patients with normal alanine aminotransferase (ALT) levels (females, < 19 IU/mL; males, < 30 IU/mL) were compared with those of 1497 immune-active (IA)-phase patients (ALT = 80 IU/mL) treated with nucleos(t)ide analogues. Results The IT group was significantly younger than the IA group (mean age, 38 vs 40 years at baseline, p=0.04). The 10-year estimated cumulative incidences of HCC (12.7% vs 6.1%; p=0.001) and death/transplantation (9.7% vs 3.4%; p<0.001) were significantly higher in the IT group than the IA group. In multivariable analyses, the IT group showed a significantly higher risk of HCC (HR 2.54; 95% CI 1.54 to 4.18) and death/transplantation (HR 3.38; 95% CI 1.85 to 6.16) than the IA group, which was consistently identified through inverse probability treatment weighting, propensity score-matched and competing risks analyses. Conclusions Untreated IT-phase patients with CHB had higher risks of HCC and death/transplantation than treated IA-phase patients. Unnecessary deaths could be prevented through earlier antiviral intervention in select IT-phase patients.
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