Natural history and disease progression in Chinese chronic hepatitis B patients in immune‐tolerant phase†

Abstract

In view of the findings that high hepatitis B virus (HBV) deoxyribonucleic acid (DNA) is associated with increased risk of chronic hepatitis B (CHB)-related complications, disease progression in CHB patients in the immune-tolerant phase is uncertain. We evaluated disease progression in 57 immune-tolerant CHB patients with high HBV DNA. Each subject underwent an initial liver biopsy. In those who remained in the immune-tolerant phase, a follow-up liver biopsy was performed after 5 years of follow-up. Patients who developed elevated serum alanine aminotransferase (ALT) levels were discontinued from the study after a follow-up liver biopsy. Traditionally, serum alanine aminotransferase (ALT) level and HBV serology analysis have been widely used for the assessment of patients with CHB infection. The annual incidence of cirrhosis has been estimated to be 2%-6% for hepatitis B e antigen (HBeAg)-positive CHB patients and 8%-10% for HBeAg-negative CHB patients. 4,5 The higher incidence of cirrhosis among HBeAg-negative patients is related to older age and more advanced liver disease at presentation. 2,4,5 More advanced fibrosis stage at presentation correlates with risk of cirrhosis, and those with milder forms of hepatitis have a longer time to cirrhosis. 6 HBeAg positivity has also been found to be associated with higher hepatic inflammation and an increased risk of HCC. Although seroconversion of HBeAg to hepatitis B e antibody (anti-HBe) often leads to hepatic inflammation subsiding and an improved prognosis, the identification of precore/core promoter mutations and recognition of HBeAg-negative CHB disease explain the disease progression noted after HBeAg seroconversion. [7][8][9][10] Recent studies have demonstrated a strong link between viral replication, liver injury, and progression to cirrhosis with increased risk of HCC in CHB-infected From the

HBeAg seroconversion as an important end point in the treatment of chronic hepatitis B

“…Individuals with perinatal acquisition of HBV typically have a prolonged immunetolerant phase that can last up to three decades. A 5-year follow-up study of individuals who remain in the immunetolerant phase showed no or minimal disease progression [29]. In natural history studies of Asian HBsAg-positive children, the rate of spontaneous HBeAg seroconversion is low: \2% per year among children 3 years or younger and 4-5% per year in older children [30].…”

Role of viral factors in the natural course and therapy of chronic hepatitis B

“…The liver disease activities are low in this phase despite active HBV replication [9]. A recent report from Hong Kong indicated that adult HBV carriers who remain in the immune tolerance phase have minimal disease progression [10]. After 2-3 decades of persistent infection, chronic hepatitis B enters the second immune clearance phase.…”

Liver Enzymes Correlation among Chronic Hepatitis C Patients with Virus Infection Fibrosis Progression

“…A study conducted by Hui et al 10 revealed that elevated levels of ALT are taken as a marker for immune clearance and used as predictive measure to evaluate the progression of disease. According to the guidelines given by AASLD, the patients with HCV infection need to be monitored by every 3 months during their first year to verify them as inactive carrier of HCV 11 .…”