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Episodic Detectable Viremia Does Not Affect Prognosis in Untreated Compensated Cirrhosis With Serum Hepatitis B Virus DNA <2,000 IU/mL

Authors
 Hye Won Lee  ;  Soo Young Park  ;  Yu Rim Lee  ;  Hyein Lee  ;  Jae Seung Lee  ;  Seung Up Kim  ;  Jun Yong Park  ;  Do Young Kim  ;  Sang Hoon Ahn  ;  Beom Kyung Kim 
Citation
 AMERICAN JOURNAL OF GASTROENTEROLOGY, Vol.117(2) : 288-294, 2022-02 
Journal Title
AMERICAN JOURNAL OF GASTROENTEROLOGY
ISSN
 0002-9270 
Issue Date
2022-02
MeSH
Biomarkers / blood ; Cross-Sectional Studies ; DNA, Viral / blood* ; Disease Progression ; Female ; Hepatitis B virus / genetics* ; Hepatitis B, Chronic / blood ; Hepatitis B, Chronic / complications* ; Hepatitis B, Chronic / virology ; Humans ; Liver Cirrhosis / blood ; Liver Cirrhosis / diagnosis ; Liver Cirrhosis / etiology* ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Viral Load* ; Viremia / complications ; Viremia / diagnosis* ; Viremia / virology
Abstract
Introduction: The necessity of antiviral therapy (AVT) for hepatitis B virus (HBV)-infected compensated cirrhosis with low-level viremia (LLV) is controversial. Herein, we evaluated its natural history.

Methods: From 3 tertiary hospitals, we enrolled untreated patients with compensated cirrhosis with persistent serum HBV-DNA levels <2,000 IU/mL; LLV was defined as having at least 1 detectable serum HBV-DNA (20-2,000 IU/mL) episode, whereas maintained virological response (MVR) was defined as having persistently undetectable serum HBV-DNA (<20 IU/mL). When serum HBV-DNA was ≥2,000 IU/mL during follow-up, AVT was administered according to guidelines. Study end points were development of cirrhotic complication event (CCE) or hepatocellular carcinoma (HCC).

Results: Among 567 patients analyzed, cumulative HCC risk at 3, 5, and 7 years was comparable between LLV (n = 391) vs MVR (n = 176) groups (5.7%, 10.7%, and 17.3% vs 7.2%, 15.5%, and 19.4%, respectively [P = 0.390]). CCE risk was also comparable between 2 groups (7.5%, 12.8%, and 13.7% vs 7.8%, 12.3%, and 14.6%, respectively [P = 0.880]). By multivariate analysis, LLV (vs MVR) was not associated with HCC or CCE risks, with adjusted hazard ratios of 1.422 (95% confidence interval [CI] 0.694-2.913; P = 0.336) and 1.816 (95% CI: 0.843-3.911; P = 0.128), respectively. Inverse probability of treatment weighting analysis yielded comparable outcomes between 2 groups, regarding HCC and CCE risks with hazard ratios of 0.903 (95% CI: 0.528-1.546; P = 0.711) and 1.192 (95% CI: 0.675-2.105; P = 0.545), respectively.

Discussion: Episodic LLV among untreated patients with compensated cirrhosis does not increase the risk of disease progression compared with MVR status. Thus, the benefits of AVT for episodic LLV should be re-evaluated.
Full Text
https://journals.lww.com/ajg/Fulltext/2022/02000/Episodic_Detectable_Viremia_Does_Not_Affect.20.aspx
DOI
10.14309/ajg.0000000000001497
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Do Young(김도영)
Kim, Beom Kyung(김범경) ORCID logo https://orcid.org/0000-0002-5363-2496
Kim, Seung Up(김승업) ORCID logo https://orcid.org/0000-0002-9658-8050
Park, Jun Yong(박준용) ORCID logo https://orcid.org/0000-0001-6324-2224
Ahn, Sang Hoon(안상훈) ORCID logo https://orcid.org/0000-0002-3629-4624
Lee, Jae Seung(이재승) ORCID logo https://orcid.org/0000-0002-2371-0967
Lee, Hye Won(이혜원) ORCID logo https://orcid.org/0000-0002-3552-3560
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/187983
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