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