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Long-term outcomes of chronic hepatitis B virus infection in the era of antiviral therapy in Korea

 Yoon Hea Park  ;  Beom Kyung Kim  ;  Ja Kyung Kim  ;  Hyeon Chang Kim  ;  Do Young Kim  ;  Jun Yong Park  ;  Kwang-Hyub Han  ;  Seung Up Kim  ;  Seung Hwan Shin  ;  Kyu Yeon Hahn  ;  Sang Hoon Ahn 
 Journal of Gastroenterology and Hepatology, Vol.29(5) : 1005-1011, 2014 
Journal Title
 Journal of Gastroenterology and Hepatology 
Issue Date
Adult ; Age Factors ; Antiviral Agents/therapeutic use* ; Carcinoma, Hepatocellular/epidemiology ; Carcinoma, Hepatocellular/etiology ; Carcinoma, Hepatocellular/prevention & control ; Disease Progression ; Female ; Follow-Up Studies ; Guanine/analogs & derivatives ; Guanine/therapeutic use ; Hepatitis B, Chronic/complications ; Hepatitis B, Chronic/drug therapy* ; Hepatitis B, Chronic/virology ; Humans ; Lamivudine/therapeutic use* ; Liver Cirrhosis/epidemiology ; Liver Cirrhosis/etiology ; Liver Cirrhosis/prevention & control ; Liver Neoplasms/epidemiology ; Liver Neoplasms/etiology ; Liver Neoplasms/prevention & control ; Male ; Middle Aged ; Republic of Korea/epidemiology ; Thymidine/analogs & derivatives ; Thymidine/therapeutic use ; Time Factors ; Treatment Outcome
antiviral therapy ; chronic hepatitis B ; cirrhosis ; decompensation ; hepatocellular carcinoma ; prognosis
BACKGROUND AND AIMS: Chronic hepatitis B (CHB) can progress to cirrhosis, hepatocellular carcinoma (HCC), and ultimately liver-related deaths. Recently, owing to potent antiviral therapy with minimal side-effects, sustained suppression of hepatitis B virus replication can be achieved, thereby preventing such complications. We aimed to reappraise clinical courses regarding disease progression in the era of antiviral therapy. METHODS: Between 2001 and 2005, treatment-naïve Korean CHB patients without cirrhosis were enrolled and followed up for at least 5 years. During follow up, antiviral therapy was commenced according to Korean Association for the Study of the Liver guidelines, if eligible, and ultrasonography and laboratory and clinical assessment were performed regularly. Primary end-points were development of cirrhosis, hepatic decompensation, HCC, or liver-related deaths. RESULTS: Of 360 patients, 323 (89.7%) received antiviral therapy such as lamivudine (70.6%), entecavir (8.7%), or telbivudine (6.5%). During follow up, cirrhosis developed in 29 (8.1%), hepatic decompensation in 4 (1.1%), and HCC in 15 (4.2%) patients. Annual incidences of cirrhosis, hepatic decompensation, and HCC were 1.05%, 0.14%, and 0.53% per person-year, respectively. Age was an independent predictor for developing cirrhosis (hazard ratio [HR] 1.075, 95% confidence interval [CI] 1.037-1.116; P < 0.001), whereas age (HR 1.060, 95% CI 1.012-1.111; P = 0.014) and cirrhosis (HR 17.470, 95% CI 5.081-60.063; P < 0.001) were those for developing HCC. CONCLUSIONS: In the era of antiviral therapy, overall clinical courses have been much improved since introduction of lamivudine in 1999. However, patients with older age or cirrhosis are still subject to HCC development despite appropriate antiviral therapy, necessitating cautious surveillance.
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1. College of Medicine (의과대학) > Dept. of Preventive Medicine and Public Health (예방의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
7. Others (기타) > Dept. of Health Promotion (건강의학과) > 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
Kim, Ja Kyung(김자경) ORCID logo https://orcid.org/0000-0001-5025-6846
Kim, Hyeon Chang(김현창) ORCID logo https://orcid.org/0000-0001-7867-1240
Park, Yoon Hea(박윤혜)
Park, Jun Yong(박준용) ORCID logo https://orcid.org/0000-0001-6324-2224
Shin, Seung Hwan(신승환)
Ahn, Sang Hoon(안상훈) ORCID logo https://orcid.org/0000-0002-3629-4624
Han, Kwang-Hyub(한광협) ORCID logo https://orcid.org/0000-0003-3960-6539
Hahn, Kyu Yeon(한규연)
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