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HCC, mortality risks elevated in immune-tolerant phase of chronic hepatitis B

11 Nov 2017

The risks of hepatocellular carcinoma (HCC) and death/transplantation in chronic hepatitis B virus (HBV) infection appear to be greater in untreated immune-tolerant (IT)-phase patients than in treated immune-active (IA)-phase patients, a study has found.

Researchers examined 1,910 chronic HBV patients with HBV DNA levels ≥20 000 IU/mL and no evidence of cirrhosis. They evaluated the clinical outcomes in untreated IT-phase patients (n=413) with normal alanine aminotransferase (ALT) levels (females, <19 IU/mL; males, <30 IU/mL) against those in IA-phase patients (n=1,497) with elevated ALT levels (≥80 IU/mL) and treated with nucleos(t)ide analogues.

Compared with the IA group, the IT group was significantly younger (mean age at baseline, 38 vs 40 years; p=0.04). Moreover, the IT group had significantly higher 10-year estimated cumulative incidences of HCC (12.7 vs 6.1 percent; p=0.001) and death/transplantation (9.7 vs 3.4 percent; p<0.001).

On Cox analysis, the IT phase was associated with markedly greater risks of HCC (hazard ratio [HR], 2.54; 95 percent CI, 1.54 to 4.18) and death/transplantation (HR, 3.38; 1.85 to 6.16). The elevation in the said risks was consistently identified through inverse probability treatment weighting, propensity score-matched and competing risks analyses.

Factors predictive of clinical events included older age (year; HR, 1.07), male sex (HR, 2.30), lower HBV DNA levels (log10 IU/mL; HR, 0.62) and lower platelet counts (×109 /L; HR, 0.99).

The present data suggest that “many unnecessary deaths could be prevented by earlier antiviral intervention in the IT phases before the appearance of clinically active liver disease,” researchers said.

Additional studies should be conducted to explore the potential of new emerging biomarkers for HBV infection in stratifying the patients for the risk of clinical events, as well as to evaluate the long-term clinical outcomes of the IT-phase patients with or without antiviral treatment, researchers added.

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Most Read Articles
Tristan Manalac, Yesterday
Of the newly identified genetic loci for primary angle-closure glaucoma (PACG), two are significantly associated with primary angle-closure suspect (PACS), indicating involvement in the earlier stages of the disease, a recent Singapore study has shown.
4 days ago
Use of proton pump inhibitors (PPIs), even at higher cumulative levels, does not increase the risk for dementia, a recent study has shown.
11 Feb 2018
In males with primary or secondary hypogonadism (HG), adherence to topical testosterone therapy (TTh) appears to improve total testosterone and decrease the risk of conditions associated with HG, a recent study has shown.
4 days ago
Persons with congenital heart disease (CHD) are at a higher risk of dementia, particularly early-onset dementia, than the general population, a recent study has shown.