Hepatitis
B Patients Who Spontaneously Clear HBeAg and Achieve Sustained Remission have
Reduced Liver Fibrosis Progression Chronic
hepatitis B virus (HBV) infection is one of the leading causes of liver disease
worldwide, and the disease is endemic throughout Asia. Over time, HBV infection
can lead to advanced liver fibrosis, cirrhosis,
and hepatocellular carcinoma.
Recently,
controversies have arisen about whether hepatitis B "e" antigen (HBeAg)
seroconversion can lead to regression or improvement of existing fibrosis, thus
improving clinical outcomes, wrote C.K. Hui from the University of Hong Kong and
colleagues in the September 2007 issue of Hepatology.
The investigators
conducted a study to determine if spontaneous HBeAg seroconversion was associated
with regression of fibrosis in Chinese chronic hepatitis B patients. They evaluated
liver tissue samples from 128 HBeAg positive treatment-naive Chinese patients
who underwent 2 liver biopsies.
Sustained disease remission was defined
as HBeAg seroconversion and HBV DNA < 104 copies/mL at follow-up liver biopsy.
The average time between the initial and follow-up biopsies was about 44 months.
Regression of fibrosis was defined as a decrease in fibrosis stage of at least
1 point.
Results •
Regression
of fibrosis was greater in individuals with sustained disease remission: 5 of
13 patients (38.5%) vs 22 of 115 patient (19.1%); P < 0.00005.
•
Fibrosis
regression was also greater in:
•
Patients who were younger (20-29 years old) at initial liver biopsy compared with
older individuals: 17of 54 (31.5%) vs 10 of 74 (13.5%); P = 0.0004;
•
Patients with HBV genotype B: 17of 43 (39.5%) vs 10 of 85 (11.8%); P = 0.004.
•
In
a multivariate analysis, sustained disease remission (relative risk [RR] 3.00;
P = 0.01) and being 20-29 years old at initial liver biopsy (RR 2.94; P = 0.04)
were independently associated with greater regression of fibrosis.
•
The
rate of fibrosis progression was lower in patients with sustained disease remission
than in those who remained HBeAg positive (median fibrosis units per year 0 vs
0.5; P = 0.02).
Conclusion
Based
on these findings, the authors concluded, "Spontaneous sustained remission
of disease is associated not only with little progression of fibrosis but also
with regression of fibrosis."
10/19/07
Reference
CK
Hui, N Leung, TW Shek, and others. Sustained disease remission after spontaneous
HBeAg seroconversion is associated with reduction in fibrosis progression in chronic
hepatitis B Chinese patients. Hepatology 46(3): 690-698. September 2007.
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