Overview of the Natural History of Chronic Hepatitis B

Hepatitis B Virus

In the advance online edition of the Journal of Hepatology, Fattovich Giovanna and colleagues presented an overview of the natural history of chronic hepatitis B, with an emphasis on the rate of disease progression and factors influencing the course of the liver disease.

Among the major points of the review were the following:

• Hepatitis B virus (HBV) infection is complex and its course is highly variable.

• Chronic hepatitis B is characterized by an early replicative phase, or HBeAg positive chronic hepatitis.

• This is followed by a late low or non-replication phase with HBeAg seroconversion and liver disease remission, known as the inactive carrier state.

• Most infected adults become inactive carriers after spontaneous HBeAg seroconversion, with good long-term prognosis.

• However, progression to HBeAg negative chronic hepatitis -- due to infection with mutant HBV variants that do not express the “e” antigen --occurs at a rate of 1-3 per 100 person-years following HBeAg seroconversion.

• The incidence of liver cirrhosis appears to be about twice as high in HBeAg negative compared with HBeAg positive chronic hepatitis B patients.

• In patients with cirrhosis, the 5-year cumulative risk of developing hepatocellular carcinoma is 17% in East Asia (where HBV is endemic) and 10% in Western Europe and the U.S.

• The 5-year rate of liver-related death is 14% in East Asia and 15% in Europe.

In conclusion, the authors wrote, “There is a growing understanding of viral, host, and environmental factors influencing disease progression, which ultimately could improve the management of chronic hepatitis B.”

Department of Surgical and Gastroenterological Sciences, University of Verona, Verona, Italy; Fifth Medical Clinic, University of Padova, Italy; Institute of Hygiene, Epidemiology and Public Health, University of Brescia, Italy.

1/18/08

Reference

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