The fate of chronic hepatitis B in the era of antiviral therapy

Abstract

Background/Aims: Chronic hepatitis B (CHB) can progress to cirrhosis and hepatocellular carcinoma (HCC), either of which can lead to a liver-related death. The progression of liver disease in hepatitis B virus (HBV) infection is fostered by active virus replication. Recently, antiviral therapy with minimal side effects have become available to achieve sustained suppression of HBV replication, thereby preventing cirrhosis, hepatic failure, and, ultimately, HCC. The aim of this study is to reappraise the clinical courses regarding disease progression in the era of antiviral therapy for Korean CHB patients who were potential candidates for antiviral therapy.Methods: Between 2001 and 2005, treatment-naïve CHB patients without cirrhosis were enrolled and followed-up for at least 5years. During follow-up period, patients have received antiviral therapy according to the Korean Association for the Study of the Liver (KASL) guideline, if indicated. Ultrasonography and laboratory and clinical assessment were performed regularly. Primary endpoints were development of cirrhosis, or hepatic decompensation, HCC, or liver-related deaths, which were examined using Kaplan-Meier method.Results: Of 360 patients, 323 (89.7%) received antiviral therapy such as lamivudine (70.6%), entecavir (8.7%), or telbivudine (6.5%). During a median follow-up period of 94 months, cirrhosis developed in 29 (8.1%) patients, hepatic decompensation in 4 (1.1%) patients, and HCC in 15 (4.2%) patients. The annual incidence of cirrhosis, hepatic decompensation, and HCC were 1.05%, 0.14%, and 0.53% per person-year, respectively. Age was an independent prognostic factor for developing cirrhosis (hazard ratio [HR] 1.075; 95% confidence interval [CI] 1.037–1.116), whereas those for developing HCC were age (HR 1.060, 95% CI 1.012–1.111) and progression to cirrhosis (HR 17.470, 95% CI 5.081–60.063).Conclusions: In the era of antiviral therapy, the overall clinical courses of patients with CHB in Korea have been much improved since the introduction of lamivudine in 1999. However, older age and cirrhosis still remain risk factors for HCC