The natural history of chronic hepatitis B virus
(HBV) infection varies depending upon whether a patient has hepatitis B "e"
antigen (HBeAg) positive or negative disease.
As reported in the January
9, 2008 advance online edition of the Journal of Viral Hepatitis, Greek researchers
evaluated changes over time in HBV viremia and predictors of disease progression
in a prospectively followed cohort of 150 untreated patients with HBeAg negative
hepatitis B.
Based on outcomes during the first year of follow-up, 85
patients were classified as inactive carrier state and 65 as chronic hepatitis
B. Serum HBV DNA levels were determined at baseline in all patients, at year 1
in carriers, at the last pre-treatment visit in chronic hepatitis B patients,
and at the time of alanine aminotransferase (ALT) elevation in carriers who progressed
to chronic infection.
Results
•
HBV DNA levels on any
occasion were:
•
> 80 IU/mL
in 81% of carriers and 100% of chronic hepatitis B patients;
•
> 2000 IU/mL
in 23% of carriers and 95% of chronic patients;
•
> 20,000
IU/mL in 0% of carriers and 83% of chronic patients.
•
The cumulative progression
rate from carrier state to chronic hepatitis B was:
•
11% at 2 years;
•
16% at 3 years;
•
24% at 4 years.
•
Progression to chronic
infection was independently associated with higher baseline ALT (but always within
the traditional normal range) and baseline HBV DNA > 2000 or >
5000 IU/mL.
•
In 12 carriers who
progressed to chronic infection, HBV DNA increased by > 1 log10 IU/mL.
•
During a median 7.5
months of follow-up, an HBV DNA change > 1 log10 IU/mL was observed
in 49% of chronic hepatitis B patients.
Conclusion
In
conclusion, the authors wrote, "serum HBV DNA levels are detectable in the
majority of inactive HBV carriers, exceeding 2000 IU/mL in only 23% and 20,000
IU/mL in none of them."
"Carriers have approximately 15% 3-year
risk of progression to chronic hepatitis B, which is associated with higher baseline
ALT and viremia ? 2000-5000 IU/mL, and thus should be closely followed,"
they continued.
Finally, they added, "Approximately 20% of HBeAg
negative chronic hepatitis B patients have HBV DNA < 20 000 IU/mL with fluctuations
>1 log10 occurring in many of them."
1/29/08
Reference GV
Papatheodoridis, N Chrysanthos, E Hadziyannis, and others. Longitudinal changes
in serum HBV DNA levels and predictors of progression during the natural course
of HBeAg-negative chronic hepatitis B virus infection. Journal of Viral Hepatitis.
January 9, 2008 [Epub ahead of print]
