Natural history and disease progression in Chinese chronic hepatitis B patients in immune-tolerant phase

✍ Scribed by Chee-Kin Hui; Nancy Leung; Siu-Tsan Yuen; Hai-Ying Zhang; Kar-Wai Leung; Lei Lu; Stephen K. F. Cheung; Wai-Man Wong; George K. Lau

• Publisher: John Wiley and Sons
• Year: 2007
• Tongue: English
• Weight: 156 KB
• Volume: 46
• Category: Article
• ISSN: 0270-9139
• DOI: 10.1002/hep.21724

✦ Synopsis

In view of the findings that high hepatitis B virus (HBV) deoxyribonucleic acid (DNA) is associated with increased risk of chronic hepatitis B (CHB)-related complications, disease progression in CHB patients in the immune-tolerant phase is uncertain. We evaluated disease progression in 57 immune-tolerant CHB patients with high HBV DNA. Each subject underwent an initial liver biopsy. In those who remained in the immune-tolerant phase, a follow-up liver biopsy was performed after 5 years of follow-up. Patients who developed elevated serum alanine aminotransferase (ALT) levels were discontinued from the study after a follow-up liver biopsy. Disease progression was defined as a 1-point increase in fibrosis stage. Initial liver biopsies showed the median fibrosis stage of the study patients was 1 (range 0-1). By the end of follow-up, 9 of the 57 patients (15.8%) had developed elevated serum ALT. In those who remained in the immune-tolerant phase, follow-up fibrosis stage was comparable with the initial fibrosis stage (P = 0.58). However, disease progression was greater in patients who developed elevated serum ALT when compared with those who remained in the immune-tolerant phase (5 of 9 vs. 3 of 48, respectively, P = 0.001). The median rate of fibrosis progression of patients who remained in the immune-tolerant phase was lower than that of patients with high serum ALT (0 U/year [range -0.40-0.20 U/year] versus 0.21 U/year [range 0-1.11 U/year], respectively, P = 0.04).

Conclusion:

Chb patients in the immune-tolerant phase have mild disease. in those who remained in the immune-tolerant phase in the present study, disease progression was minimal. however, immune-tolerant patients who progressed to the immune clearance phase often faced disease progression.