Premium
Anti‐viral therapy can be delayed or avoided in a significant proportion of HB eAg‐negative Caucasian patients in the Grey Zone
Author(s) -
Bonacci M.,
Lens S.,
Mariño Z.,
Londoño M.C.,
RodríguezTajes S.,
Mas A.,
GarcíaLópez M.,
PérezdelPulgar S.,
SánchezTapias J. M.,
Forns X.
Publication year - 2018
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.14613
Subject(s) - medicine , hbsag , gastroenterology , cirrhosis , hbeag , genotype , chronic hepatitis , hepatitis b virus , immunology , virus , biology , biochemistry , gene
Summary Background Grey Zone ( GZ ) is an ill‐defined situation including patients falling between inactive carrier ( IC ) state and HB eAg‐negative chronic hepatitis B ( HB eAg‐negative CHB ). Aims To assess the long‐term outcomes of GZ patients compared to IC in the absence of treatment. Methods Retrospective analysis of 287 IC and GZ HB eAg‐negative patients. Patients were classified into 4 groups at baseline: HBV ‐ DNA <2000 IU/mL and ALT <40 U/L ( IC ), HBV ‐ DNA <2000 IU / mL and ALT 40‐80 U/L ( GZ ‐1), HBV ‐ DNA 2000‐20 000 IU / mL and ALT <40 U/L ( GZ ‐2) or ALT 40‐80 U/L ( GZ ‐3). Data were also analysed using AASLD ALT criteria. Results After a median follow‐up of 8.2 (5‐19) years, HB sAg loss occurred in about 15% IC s or GZ patients. Transition into IC state occurred in 40% of GZ patients. DNA fluctuations >2000 IU / mL correlated inversely with transition into IC and HB sAg loss. HB sAg levels were significantly lower in IC s than in GZ patients (338 IU / mL [20‐3269] vs 5763 IU / mL [2172‐17 754]; P < 0.05). Among the latter group, there was an increasing gradient of HB sAg levels from GZ ‐1 to GZ ‐3 patients ( P < 0.05). HB eAg‐negative CHB occurred in only 18 (6.3%) GZ patients. No patient developed cirrhosis nor advanced fibrosis. ALT / HBV ‐ DNA fluctuations and HB eAg‐negative CHB development were more frequent in genotype B/C patients, whereas HB sAg loss occurred only in genotype A/D patients. Conclusions Most Caucasian GZ patients present excellent long‐term outcomes in the absence of treatment, with a high rate of HB sAg loss and low rate of progression to HB eAg‐negative CHB . HBV ‐genotyping and HB sAg levels could help to predict outcomes and better classify GZ patients.