High Risk of Hepatitis B Virus Reactivation in Nucleos(t)ide Analogue-Induced Hepatitis B e Antigen Seroconverters Older Than 40 Years
Digestive Diseases and Sciences (Impact Factor: 2.61). 05/2014; 59(10). DOI: 10.1007/s10620-014-3194-3
A recent study showed that chronic hepatitis B virus (HBV) carriers with nucleos(t)ide analogue (NA)-induced hepatitis B antigen (HBeAg) seroconversion occurring before the age of 30 years have a higher risk of HBV reactivation. To compare the risk of HBV reactivation and HBeAg seroreversion between patients with spontaneous and NA-induced HBeAg seroconversion. A total of 135 and 251 non-cirrhotic patients with NA-induced and spontaneous HBeAg seroconversion, respectively, were analyzed. NA-induced HBeAg seroconverters faced higher risks of HBV reactivation and HBeAg seroreversion than spontaneous HBeAg seroconverters (P < 0.001). In spontaneous HBeAg seroconverters, age at HBeAg seroconversion, sex, HBV DNA levels before HBeAg seroconversion, HBV genotype C, and pre-S deletions were independent predictors of HBV reactivation. In NA-induced HBeAg seroconverters, only age at baseline was an independent predictor of HBV reactivation. To determine whether the difference in the incidence of HBV reactivation or HBeAg seroreversion between two groups was age-specific, we analyzed these patients according to their age at HBeAg seroconversion (20-29, 30-39, and a parts per thousand yen40 years). Our data showed that NA-induced HBeAg seroconversion was an independent predictor of HBV reactivation and HBeAg seroreversion than spontaneous HBeAg seroconversion in patients older than 40 years at HBeAg seroconversion, but not in patients between 20-29 and 30-39 years of age. NA-induced HBeAg seroconverters are associated with higher risks of HBV reactivation and HBeAg seroreversion compared to spontaneous HBeAg seroconverters, especially in patients who are older than 40 years at HBeAg seroconversion.
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ABSTRACT: There are etiologic variations of hepatocellular carcinoma (HCC) in different geographic areas. Taiwan is a hyperendemic area for hepatitis B virus (HBV) infection. Hepatitis C virus (HCV) infection also plays an important role in HCC development in Taiwan. Identification of local HCV-endemic areas is important to keep HCV from spreading. This study investigated the etiologic variations of HCC in different geographic areas of Taiwan. The authors evaluated the hepatitis B surface antigen (HBsAg) and antibodies to HCV (anti-HCV) status of 284 patients (232 male, 52 female) with HCC. They also evaluated the gender ratio and mean age of these patients. The mean age of HBsAg positive patients was significantly lower than the mean age of HBsAg negative patients (52.6 +/- 12.3 vs. 61.3 +/- 11.2 years) (P < 0.05). The male-to-female ratio was 4.5:1 for all HCC patients, 7:1 for HBsAg positive HCC patients, and 2.8:1 for anti-HCV positive HCC patients. In Chaiyi County in southern Taiwan, the prevalence of anti-HCV in male HCC patients was 52%, significantly greater than that of Taiwan as a whole (27.6%) (P = 0.07). However, the prevalence of anti-HCV in male HCC patients in Taipei County in northern Taiwan was 8.7%, significantly less than that of Taiwan as a whole (P = 0.043). Of a total of 65 Chiayi-based HCC patients, 55.4% were anti-HCV positive and 46.2% were HBsAg positive. In the Chiayi area, results of multiple logistic regression showed that the HCC patients who were age 60 years or older or who were living in the city area both had highly HCV-related disease. The mean age of patients with HBV-related HCC was significantly lower than that of patients with non-HBV-related HCC. The male-to-female ratio for patients with HBV-related HCC was significantly higher than that of patients with HCV-related HCC. The authors identified an area of Taiwan in which HCV-related HCC was prevalent.Cancer 11/1999; 86(7):1143-50. · 4.89 Impact Factor
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ABSTRACT: HBeAg-negative CHB has now a worldwide distribution, developing in the course of HBeAg-positive chronic HBV infection during or after the phase of HBeAg loss and its seroconversion to anti-HBe. It is caused by replicating noncytopathic HBV mutants either unable to produce HBeAg (precore mutants) or with down-regulated transcription of the precore/core messenger RNA (BCP mutants). The most frequently encountered and stable HBeAg-negative mutants in the world are those with a novel translational precore stop codon. They are HBV genotype determined and become selected in genotypes B, C, D, and E (non-A genotypes). They prevail in South Europe, the Mediterranean basin, and Asia, whereas they are rather infrequent in the United States. The incidence of HBeAg-negative CHB is increasing in the world. The selection of HBeAg-negative HBV mutants is determined both by viral and host factors, the same being true for their ability to replicate in the presence of anti-HBe immunity. Clinical, virologic, and biochemical features as well as the natural course of HBe-negative CHB have been reviewed, and the efficacy of IFN-α and lamivudine therapy as well as the problem of viral resistance to lamivudine have been critically presented.Hepatology 11/2001; 34(4):617–624. DOI:10.1053/jhep.2001.27834 · 11.06 Impact Factor
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ABSTRACT: During the course of chronic hepatitis B virus (HBV) infection, hepatitis B e antigen (HBeAg) seroconversion to its antibody (anti-HBe) often coincides with normalization of liver biochemical test and clinical remission, but data regarding long-term outcome after spontaneous seroconversion are still scarce. Excluding patients with other virus(es) concurrent infection, 283 patients with chronic HBV infection were followed up for at least 1 year after spontaneous HBeAg seroconversion to anti-HBe. Follow-up studies included clinical, biochemical, and virologic evaluation and hepatocellular carcinoma (HCC) screening with ultrasonography and alpha-fetoprotein assay. During a median follow-up period of 8.6 years (range, 1 to 18.4 years) after HBeAg seroconversion in 283 patients, 189 (66.8%) showed sustained remission, whereas the remaining 94 (33.2%) experienced alanine aminotransferase (ALT) elevation over twice the upper limit of normal: 12 (4.2%) associated with HBeAg reversion, 68 (24%) with detectable serum HBV DNA but HBeAg negative, and 14 (4.9%) of undetermined causes. Of the 269 patients without evidence of cirrhosis at the time of HBeAg seroconversion, 21 (7.8%) developed cirrhosis with a cumulative incidence and relative risk significantly higher in patients developing active hepatitis than in patients with sustained remission (P <.05). HCC developed in 6 (2.2%) of the 283 patients, also with a significantly higher cumulative incidence in patients developing active hepatitis after HBeAg seroconversion (P <.005). In conclusion, the results suggest that spontaneous HBeAg seroconversion confers favorable long-term outcomes. However, active hepatitis still may develop and lead to cirrhosis and HCC.Hepatology 06/2002; 35(6):1522-7. DOI:10.1053/jhep.2002.33638 · 11.06 Impact Factor
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