Premium
Low Incidence of Adverse Outcomes in Adults With Chronic Hepatitis B Virus Infection in the Era of Antiviral Therapy
Author(s) -
Lok Anna S.,
Perrillo Robert,
Lalama Christina M.,
Fried Michael W.,
Belle Steven H.,
Ghany Marc G.,
Khalili Mandana,
Fontana Robert J.,
Sterling Richard K.,
Terrault Norah,
Feld Jordan J.,
Di Bisceglie Adrian M.,
Lau Daryl T.Y.,
Hassan Mohamed,
Janssen Harry L.A.
Publication year - 2021
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.31554
Subject(s) - medicine , cirrhosis , hbeag , hbsag , hepatitis b virus , decompensation , liver transplantation , coinfection , gastroenterology , hepatitis b , immunology , transplantation , virus
Background and Aims Outcomes of persons with chronic hepatitis B virus (HBV) infection in the era of antiviral therapy (AVT) are not well characterized. We determined the incidence and factors associated with clinical outcomes in a multiethnic, North American cohort of adults with chronic HBV infection, who were not on AVT at enrollment. Approach and Results Adults with chronic HBV infection, not receiving AVT, and without a history of decompensation, HCC, or liver transplantation (LT), were prospectively followed. Participants with known human immunodeficiency virus (HIV), hepatitis C virus, or hepatitis D virus (HDV) coinfection were excluded. During follow‐up, treatment could be initiated per standard of care. Clinical outcomes included: incident cirrhosis, decompensation, HCC, OLT, and HBV‐related death. Among 1,418 participants analyzed, 51.5% were women, median age was 41.1 years, 75% were Asian, 10% White, 13% Black, 24% HBeAg(+), and 1.5% cirrhosis at baseline. During the study, 274 started treatment, 83 had an alanine aminotransferase flare, 118 of 330 initially HBeAg(+) became HBeAg(−), and 90 of 1,329 became HBsAg(−). After 6,641 person‐years follow‐up, 8 participants (4 of 21 with baseline cirrhosis) had 12 clinical outcomes (2 decompensation, 5 HCC, 2 OLT, and 3 HBV‐related deaths) and 19 of 1,397 had incident cirrhosis. Twenty‐one of 26 participants had first outcome before treatment, none had become HBsAg(−), whereas 5/9 HBeAg(+) had become HBeAg(−) at time of first outcome. Cumulative percentage of clinical outcomes was 16% at year 4 in participants with baseline cirrhosis and 2% (including incident cirrhosis) at year 7 in those without. Conclusions Incidence of adverse outcomes was low in this closely monitored, large cohort of North American adults with predominantly inactive, chronic HBV without cirrhosis. Our data highlight the benefits of HBsAg loss and the importance of early diagnosis and treatment to prevent cirrhosis and other complications of chronic HBV infection.