Anna S Lok1, Robert Perrillo2, Christina M Lalama3, Michael W Fried4, Steven H Belle5, Marc G Ghany6, Mandana Khalili7, Robert J Fontana1, Richard K Sterling8, Norah Terrault9, Jordan J Feld10, Adrian M Di Bisceglie11, Daryl T Y Lau12, Mohamed Hassan13, Harry L A Janssen14. 1. Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA. 2. Hepatology Division, Baylor Scott and White Medical Center, Dallas, TX. 3. Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. 4. UNC Liver Center, University of North Carolina at Chapel Hill, Chapel Hill, NC. 5. Epidemiology and Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. 6. Liver Diseases Branch, NIDDK, NIH, Bethesda, MD. 7. Department of Medicine, Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, CA. 8. Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University, Richmond, VA. 9. Division of Gastrointestinal and Liver Diseases, Keck Medicine of University of Southern California, Los Angeles, CA. 10. Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, ON, Canada. 11. Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO. 12. Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. 13. Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolois, MN. 14. Toronto Centre for Liver Disease, University of Toronto, Toronto, ON, Canada.
Abstract
BACKGROUND AND AIMS: Outcomes of persons with chronic hepatitis B virus (HBV) infection in the era of antiviral therapy (AVT) are not well characterized. We determined the incidence and factors associated with clinical outcomes in a multiethnic, North American cohort of adults with chronic HBV infection, who were not on AVT at enrollment. APPROACH AND RESULTS: Adults with chronic HBV infection, not receiving AVT, and without a history of decompensation, HCC, or liver transplantation (LT), were prospectively followed. Participants with known human immunodeficiency virus (HIV), hepatitis C virus, or hepatitis D virus (HDV) coinfection were excluded. During follow-up, treatment could be initiated per standard of care. Clinical outcomes included: incident cirrhosis, decompensation, HCC, OLT, and HBV-related death. Among 1,418 participants analyzed, 51.5% were women, median age was 41.1 years, 75% were Asian, 10% White, 13% Black, 24% HBeAg(+), and 1.5% cirrhosis at baseline. During the study, 274 started treatment, 83 had an alanine aminotransferase flare, 118 of 330 initially HBeAg(+) became HBeAg(-), and 90 of 1,329 became HBsAg(-). After 6,641 person-years follow-up, 8 participants (4 of 21 with baseline cirrhosis) had 12 clinical outcomes (2 decompensation, 5 HCC, 2 OLT, and 3 HBV-related deaths) and 19 of 1,397 had incident cirrhosis. Twenty-one of 26 participants had first outcome before treatment, none had become HBsAg(-), whereas 5/9 HBeAg(+) had become HBeAg(-) at time of first outcome. Cumulative percentage of clinical outcomes was 16% at year 4 in participants with baseline cirrhosis and 2% (including incident cirrhosis) at year 7 in those without. CONCLUSIONS: Incidence of adverse outcomes was low in this closely monitored, large cohort of North American adults with predominantly inactive, chronic HBV without cirrhosis. Our data highlight the benefits of HBsAg loss and the importance of early diagnosis and treatment to prevent cirrhosis and other complications of chronic HBV infection.
BACKGROUND AND AIMS: Outcomes of persons with chronic hepatitis B virus (HBV) infection in the era of antiviral therapy (AVT) are not well characterized. We determined the incidence and factors associated with clinical outcomes in a multiethnic, North American cohort of adults with chronic HBV infection, who were not on AVT at enrollment. APPROACH AND RESULTS: Adults with chronic HBV infection, not receiving AVT, and without a history of decompensation, HCC, or liver transplantation (LT), were prospectively followed. Participants with known human immunodeficiency virus (HIV), hepatitis C virus, or hepatitis D virus (HDV) coinfection were excluded. During follow-up, treatment could be initiated per standard of care. Clinical outcomes included: incident cirrhosis, decompensation, HCC, OLT, and HBV-related death. Among 1,418 participants analyzed, 51.5% were women, median age was 41.1 years, 75% were Asian, 10% White, 13% Black, 24% HBeAg(+), and 1.5% cirrhosis at baseline. During the study, 274 started treatment, 83 had an alanine aminotransferase flare, 118 of 330 initially HBeAg(+) became HBeAg(-), and 90 of 1,329 became HBsAg(-). After 6,641 person-years follow-up, 8 participants (4 of 21 with baseline cirrhosis) had 12 clinical outcomes (2 decompensation, 5 HCC, 2 OLT, and 3 HBV-related deaths) and 19 of 1,397 had incident cirrhosis. Twenty-one of 26 participants had first outcome before treatment, none had become HBsAg(-), whereas 5/9 HBeAg(+) had become HBeAg(-) at time of first outcome. Cumulative percentage of clinical outcomes was 16% at year 4 in participants with baseline cirrhosis and 2% (including incident cirrhosis) at year 7 in those without. CONCLUSIONS: Incidence of adverse outcomes was low in this closely monitored, large cohort of North American adults with predominantly inactive, chronic HBV without cirrhosis. Our data highlight the benefits of HBsAg loss and the importance of early diagnosis and treatment to prevent cirrhosis and other complications of chronic HBV infection.
Authors: George V Papatheodoridis; Vana Sypsa; George Dalekos; Cihan Yurdaydin; Florian van Boemmel; Maria Buti; John Goulis; Jose Luis Calleja; Heng Chi; Spilios Manolakopoulos; Alessandro Loglio; Spyros Siakavellas; Nikolaos Gatselis; Onur Keskın; Maria Lehretz; Savvoula Savvidou; Juan de la Revilla; Bettina E Hansen; Anastasia Kourikou; Ioannis Vlachogiannakos; Kostantinos Galanis; Ramazan Idilman; Massimo Colombo; Rafael Esteban; Harry L A Janssen; Thomas Berg; Pietro Lampertico Journal: J Hepatol Date: 2018-02-08 Impact factor: 25.083
Authors: Patrick Marcellin; Edward Gane; Maria Buti; Nezam Afdhal; William Sievert; Ira M Jacobson; Mary Kay Washington; George Germanidis; John F Flaherty; Raul Aguilar Schall; Jeffrey D Bornstein; Kathryn M Kitrinos; G Mani Subramanian; John G McHutchison; E Jenny Heathcote Journal: Lancet Date: 2012-12-10 Impact factor: 79.321
Authors: Jordan J Feld; Norah A Terrault; Hsing-Hua S Lin; Steven H Belle; Raymond T Chung; Naoky Tsai; Mandana Khalili; Robert Perrillo; Stewart L Cooper; Marc G Ghany; Harry L A Janssen; Anna S Lok Journal: Hepatology Date: 2019-03-14 Impact factor: 17.425
Authors: A M Di Bisceglie; M Lombardero; J Teckman; L Roberts; H L A Janssen; S H Belle; J H Hoofnagle Journal: J Viral Hepat Date: 2016-12-05 Impact factor: 3.728
Authors: Stuart C Gordon; Lois E Lamerato; Loralee B Rupp; Jia Li; Scott D Holmberg; Anne C Moorman; Philip R Spradling; Eyasu H Teshale; Vinutha Vijayadeva; Joseph A Boscarino; Emily M Henkle; Nancy Oja-Tebbe; Mei Lu Journal: Clin Gastroenterol Hepatol Date: 2013-10-06 Impact factor: 11.382
Authors: Norah A Terrault; Abdus S Wahed; Jordan J Feld; Stewart L Cooper; Mark G Ghany; Mauricio Lisker-Melman; Robert Perrillo; Richard K Sterling; Mandana Khalili; Raymond T Chung; Philip Rosenthal; Robert J Fontana; Arif Sarowar; Daryl T Y Lau; Junyao Wang; Anna S Lok; Harry L A Janssen Journal: Hepatology Date: 2022-01-26 Impact factor: 17.425
Authors: Donna M Evon; Hsing-Hua S Lin; Robert J Fontana; Mandana Khalili; Colina Yim; Abdus S Wahed; Jay H Hoofnagle Journal: GastroHep Date: 2021-05-05
Authors: Richard K Sterling; Wendy C King; Mandana Khalili; Raymond T Chung; Mark Sulkowski; Mamta K Jain; Mauricio Lisker-Melman; Marc G Ghany; David K Wong; Amanda S Hinerman; Atul K Bhan; Abdus S Wahed; David E Kleiner Journal: Hepatology Date: 2021-08-25 Impact factor: 17.298