Longitudinal changes in serum HBV DNA levels and predictors of progression during the natural course of HBeAg-negative chronic hepatitis B virus infection (original) (raw)

2008, Journal of Viral Hepatitis

We evaluated the longitudinal changes of viraemia and predictors of progression in a prospectively followed cohort of 150 untreated patients with HBeAgnegative chronic hepatitis B virus (HBV) infection. According to the first year of follow-up, 85 patients were classified into inactive carrier state and 65 into chronic hepatitis B (CHB). Serum HBV DNA levels were determined at baseline in all patients, at year-1 in carriers or last pretherapy visit in CHB patients and during alanine aminotransferase (ALT) elevations in carriers progressing to CHB. HBV DNA levels at any occasion were ‡80, ‡2000 or ‡20 000 IU ⁄ mL in 81%, 23% or 0% of carriers and 100%, 95% or 83% of CHB patients. The cumulative progression rate from carrier to CHB was 11%, 16%, 24% at 2-, 3-, 4 years and was independently associated with higher baseline ALT (always within traditional normal range) and baseline HBV DNA ‡2000 or ‡5000 IU ⁄ mL. In 12 carriers progressed to CHB, HBV DNA increased by >1 log 10 IU ⁄ mL. During 7.5 months of median follow-up, HBV DNA change ‡1 log 10 IU ⁄ mL was observed in 49% of CHB patients. In conclusion, serum HBV DNA levels are detectable in the majority of inactive HBV carriers exceeding 2000 IU ⁄ mL in only 23% and 20 000 IU ⁄ mL in none of them. Carriers have approximately 15% 3-year risk of progression to CHB, which is associated with higher baseline ALT and viraemia ‡2000-5000 IU ⁄ mL, and thus should be closely followed. Approximately 20% of HBeAgnegative CHB patients have HBV DNA <20 000 IU ⁄ mL with fluctuations >1 log 10 occurring in many of them.