Vincent Mallet1, Kamal Hamed2, Michaël Schwarzinger3. 1. Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Institut Pasteur, Institut National de la Santé et de la Recherche Médicale (Inserm), Unité 1223, Paris, France; Hepatology Service, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Cochin Port-Royal, Paris, France. Electronic address: vincent.mallet@aphp.fr. 2. Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA. 3. Translational Health Economics Network (THEN), Paris, France; Infection Antimicrobials Modeling & Evolution (IAME), UMR 1137, Institut National de la Santé et de la Recherche Médicale (INSERM) - Université Paris Diderot, Sorbonne Paris Cité, France.
Abstract
BACKGROUND & AIMS: How risk factors associated with chronic hepatitis B (CHB) modify liver disease progression and mortality has been scarcely reported outside of Asia. We aimed to evaluate these risk factors in a French population between 2008 and 2013. METHODS: All individuals discharged with CHB from acute and post-acute care hospitals in Metropolitan France between January 2008 and December 2013 were selected. Associations between liver- and non-liver-related risk factors and both liver disease progression (end-stage liver disease or hepatocellular carcinoma) and mortality were assessed by multivariate Cox proportional hazard models. RESULTS: Overall, liver disease progression, liver transplantation and death were recorded in 7479 (15.5%), 433 (8.2%) and 5299 (11.0%) patients, respectively. An additional liver-related risk factor was recorded in 5426 (72.6%) patients with liver disease progression and 2699 (75.5%) patients with liver transplantation or liver death. Adjusted hazard ratios (95% confidence interval) for liver disease progression of hepatitis D virus co-infection, hepatitis C virus co-infection, alcohol use disorders, diabetes mellitus, and other rare causes of chronic liver disease were 1.44 (1.35-1.53), 1.77 (1.68-1.87), 3.37 (3.20-3.55), 1.40 (1.32-1.48), and 2.19 (1.98-2.42), respectively. All liver-related risk factors increased the risk of all-cause mortality, especially after liver disease progression. Adjusted hazard ratios for liver disease progression and in-hospital mortality of HIV co-infection without acquired immune deficiency syndrome (AIDS) were 0.60 (0.52-0.70) and 0.63 (0.51-0.78), respectively. CONCLUSIONS: In France, 2008-2013, liver disease progression among patients with CHB was closely related to other risk factors. HIV co-infected patients without AIDS had better outcomes, suggesting better care in this group of patients. LAY SUMMARY: In France, 2008-2013, about three-quarters of patients with chronic hepatitis B who progressed to a liver-related complication, including liver transplantation and liver-related death, had an additional liver-related risk factor. Despite a higher prevalence of liver-related risk factors, HIV co-infected patients without AIDS had better outcomes. Prognosis of patients with chronic hepatitis B is closely related to other risk factors. Treatment of patients with chronic hepatitis B, including control of chronic hepatitis B-associated risk factors, is more efficient in HIV co-infected patients.
BACKGROUND & AIMS: How risk factors associated with chronic hepatitis B (CHB) modify liver disease progression and mortality has been scarcely reported outside of Asia. We aimed to evaluate these risk factors in a French population between 2008 and 2013. METHODS: All individuals discharged with CHB from acute and post-acute care hospitals in Metropolitan France between January 2008 and December 2013 were selected. Associations between liver- and non-liver-related risk factors and both liver disease progression (end-stage liver disease or hepatocellular carcinoma) and mortality were assessed by multivariate Cox proportional hazard models. RESULTS: Overall, liver disease progression, liver transplantation and death were recorded in 7479 (15.5%), 433 (8.2%) and 5299 (11.0%) patients, respectively. An additional liver-related risk factor was recorded in 5426 (72.6%) patients with liver disease progression and 2699 (75.5%) patients with liver transplantation or liver death. Adjusted hazard ratios (95% confidence interval) for liver disease progression of hepatitis D virus co-infection, hepatitis C virus co-infection, alcohol use disorders, diabetes mellitus, and other rare causes of chronic liver disease were 1.44 (1.35-1.53), 1.77 (1.68-1.87), 3.37 (3.20-3.55), 1.40 (1.32-1.48), and 2.19 (1.98-2.42), respectively. All liver-related risk factors increased the risk of all-cause mortality, especially after liver disease progression. Adjusted hazard ratios for liver disease progression and in-hospital mortality of HIV co-infection without acquired immune deficiency syndrome (AIDS) were 0.60 (0.52-0.70) and 0.63 (0.51-0.78), respectively. CONCLUSIONS: In France, 2008-2013, liver disease progression among patients with CHB was closely related to other risk factors. HIV co-infectedpatients without AIDS had better outcomes, suggesting better care in this group of patients. LAY SUMMARY: In France, 2008-2013, about three-quarters of patients with chronic hepatitis B who progressed to a liver-related complication, including liver transplantation and liver-related death, had an additional liver-related risk factor. Despite a higher prevalence of liver-related risk factors, HIV co-infectedpatients without AIDS had better outcomes. Prognosis of patients with chronic hepatitis B is closely related to other risk factors. Treatment of patients with chronic hepatitis B, including control of chronic hepatitis B-associated risk factors, is more efficient in HIV co-infectedpatients.
Authors: Ning Liang; De Zhao Kong; Si Si Ma; Chun Li Lu; Ming Yang; Lu Da Feng; Chen Shen; Ruo Han Diao; Ling Jun Cui; Xing Yu Lu; Dimitrinka Nikolova; Janus C Jakobsen; Christian Gluud; Jian Ping Liu Journal: Cochrane Database Syst Rev Date: 2019-04-03
Authors: De Zhao Kong; Ning Liang; Guan Lin Yang; Zhe Zhang; Yue Liu; Ye Yang; Yu Xi Liu; Qi Ge Wang; Fan Zhang; Hui Yong Zhang; Dimitrinka Nikolova; Janus C Jakobsen; Christian Gluud; Jian Ping Liu Journal: Cochrane Database Syst Rev Date: 2019-08-22
Authors: Ning Liang; De Zhao Kong; Chun Li Lu; Si Si Ma; Yu Qi Li; Dimitrinka Nikolova; Janus C Jakobsen; Christian Gluud; Jian Ping Liu Journal: Cochrane Database Syst Rev Date: 2019-06-24
Authors: Zobair Younossi; Katrin Kochems; Marc de Ridder; Desmond Curran; Eveline M Bunge; Laurence de Moerlooze Journal: Hum Vaccin Immunother Date: 2017-07-25 Impact factor: 3.452