Natural history of chronic HBV infection: A cohort study with up to 12 years follow-up in North Greece (part of the Interreg I-II/EC-project)

✍ Scribed by G.H. Zacharakis; J. Koskinas; S. Kotsiou; M. Papoutselis; F. Tzara; N. Vafeiadis; A.J. Archimandritis; K. Papoutselis

• Publisher: John Wiley and Sons
• Year: 2005
• Tongue: English
• Weight: 129 KB
• Volume: 77
• Category: Article
• ISSN: 0146-6615
• DOI: 10.1002/jmv.20434

✦ Synopsis

The aim of the study was to assess the long-term outcome of chronic hepatitis B surface antigen (HBsAg) carriers in the general population in North Greece (Thrace), an area with an intermediate endemicity. This was a part of the Interreg I-II EC project. Two hundred sixty three chronic HBsAg(þ) carriers, median age 34 years (20-65), were evaluated prospectively for a median follow-up of 5 years (2-12). Hepatitis B virus (HBV) markers and ALT were examined every 6 months and serum HBV-DNA every 12 months. Liver biopsy was undertaken at presentation and every 2-4 years. Fourteen of 263 (5.3%) subjects were HBeAg(þ) and 249/263 (94.7%) HBeAg(À)/ anti-HBe(þ) of whom 48 (19.3%) had elevated ALT, and HBV-DNA levels ranging from 1.4 Â 10 5 -4 Â 10 7 copies/ml. Inactive carriers (98/195 (50.3%)) had detectable HBV-DNA (median 2.6 Â 10 3 range 0.042 Â 10 4 -1.9 Â 10 4 copies/ml); 4/195 (2%) exhibited HBV reactivation during the observation period (all had HBV-DNA >10 4 copies/ml at presentation). Patients (7/14 (50%) HBeAg(þ)) developed anti-HBe(þ), annual rate 10%. Subjects (16/195 (8%)) lost HBsAg, all were inactive carriers; 10 developed anti-HBs (annual rate 1%). Liver biopsy was normal or with minimal changes in 92/95 (97%) inactive carriers and remained so at 4 years follow-up. In contrast, 4/48 (8.3%) HBeAg(À)/anti-HBe(þ) patients with active disease had deterioration of liver histology. In this cohort study: (a) the annual seroconversion rate was 1% for the HBsAg and 10% for the HBeAg, (b) 23.6% of the HBsAg(þ) carriers had active liver disease and 39% moderate fibrosis at presentation of whom a small proportion deteriorated over the observation period, (c) HBsAg carriers with HBV-DNA level <10 4 copies/ml had persistently normal ALT and unchanged liver histology over the follow-up period of up to 12 years.