Episodic Detectable Viremia Does Not Affect Prognosis in... : Official journal of the American College of Gastroenterology | ACG (original) (raw)

ARTICLE: LIVER

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

Lee, Hye Won MD, PhD1,2,3,*; Park, Soo Young MD, PhD4,*; Lee, Yu Rim MD, PhD4; Lee, Hyein BS3; Lee, Jae Seung MD1,2,3; Kim, Seung Up MD, PhD1,2,3; Park, Jun Yong MD, PhD1,2,3; Kim, Do Young MD, PhD1,2,3; Ahn, Sang Hoon MD, PhD1,2,3; Kim, Beom Kyung MD, PhD1,2,3

1Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea;

2Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea;

3Yonsei Liver Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea;

4Department of Internal Medicine, School of Medicine, Kyungpook National University, Daege, Republic of Korea.

Correspondence: Beom Kyung Kim, MD, PhD. E-mail: [email protected].

SUPPLEMENTARY MATERIAL accompanies this paper at https://links.lww.com/AJG/C202 and https://links.lww.com/AJG/C203

*Hye Won Lee, MD, PhD, and Soo Young Park, MD, PhD contributed equally to this work.

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.