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A long-term study of liver-related events in Caucasian hepatitis B patients with normal ALT values and high viremia

Journal Volume 85 - 2022
Issue Fasc.1 - Original articles
Author(s) Ö.M. Koc 1 2, J. Verbeek 3, G.H. Koek 4 5, R. Bielen 1 6, D. Busschots 1 6, M. Gamil 3, G. Robaeys 1 6 3, F. Nevens 3
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PAGES 56-61
(1) Faculty of Health and Life Sciences, Hasselt University, Diepenbeek, Belgium
(2) Department of Medical Microbiology, School of NUTRIM, Maastricht University Medical Centre+, Maastricht, the Netherlands;
(3) Department of Gastroenterology and Hepatology, KU Leuven University Hospitals, Leuven, Belgium
(4) Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, the Netherlands
(5) Department of Surgery, University Hospital Aachen, Aachen, Germany
(6) Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium

Background and study aims: There is ongoing debate whether antiviral therapy should be initiated in hepatitis B e antigen (HBeAg)-negative patients with normal alanine aminotransferase (ALT) levels but high HBV DNA levels >2,000 IU/mL. Since the need for antiviral therapy might be different between Asian and Caucasian patients, we studied the long-term disease outcome in Caucasian patients living in Western Europe.

Patients and methods: One hundred sixteen patients with high HBV DNA levels (>2,000 IU/mL) at diagnosis were included in the high viremia group, while those with HBV DNA <2,000 IU/mL were used as controls (n = 327). All patients were Caucasian, HBeAg negative, had normal ALT levels and had no significant liver disease at diagnosis.

Results: Median follow-up was 7 + 9.8 years in the high viremia group and this was 10 + 12.5 years in controls. The cumulative probability of a liver-related event over 10 years was 4.8% vs 0.0% in the control group (p=.008). In multivariable analysis, high viremia group was associated with the occurrence of a liver-related event (hazards ratio (HR) 95% confidence interval (CI): 1.20-11.98, p=.023). In this subgroup, older age at diagnosis (HR 95% CI: 1.01-1.16, p=.023) predicted a higher risk of liver-related event. In the high viremia group, liver-related mortality was 0.9% and none of the patients developed hepatocellular carcinoma.

Conclusions: HBV DNA >2,000 IU/mL influences the long-term disease outcome in Caucasian HBeAg-negative patients living in Western Europe. Nevertheless, the risk of liver-related events is low.

Keywords: hepatitis B, Caucasian, inactive carrier, ALT, HBV DNA.

The authors declare that they have no conflict of interest.
© Acta Gastro-Enterologica Belgica.
PMID 35304994