1Division of Gastroenterology and Hepatology, University of Michigan Health System, Ann Arbor, Michigan, USA.
2Division of Gastroenterology and Hepatology, University of Michigan Health System, Ann Arbor, Michigan, USA. Electronic address: firstname.lastname@example.org.
& Aims: The availability of potent, well-tolerated oral antivirals with low rates of resistance has led many experts to recommend liberalizing indications for treatment of chronic hepatitis B (CHB). This study sought to determine the rate of transitions to an active phase of infection, the frequency of treatment initiation, and the clinical outcomes of patients with CHB who did not meet treatment criteria at presentation.
We reviewed medical records of patients with CHB, seen in the liver clinics at the University of Michigan Health System from 1999 through 2010, who did not receive antiviral treatment within 6 months of presentation. We collected data on transitions between different phases of CHB, hepatitis B e antigen (HBeAg) seroconversion, loss of hepatitis B surface antigen (HBsAg), and development of hepatocellular carcinoma (HCC). Data analyses were censored or truncated at the time of treatment initiation or development of an outcome.
Of the 234 patients analyzed, 52.1% were men (median age, 35 years), 72.2% were Asians, and 81.2% were HBeAg-negative. During a median follow-up of 51 months, 19.2% patients transitioned to a more active disease phase and 18.8% started antiviral therapy. Of the 44 HBeAg-positive patients, 4 patients (9%) had spontaneous HBeAg seroconversion. Nine HBeAg-negative but none of the HBeAg-positive patients lost HBsAg. The cumulative probability of HBsAg loss among HBeAg-negative patients was 1% at year 5 and 21% by year 10. No patients had flares of icteric hepatitis or hepatic decompensation. None of the HBeAg-positive patients developed HCC, whereas 2 HBeAg-negative patients developed HCC.
Careful monitoring of patients with CHB who did not meet treatment criteria at presentation permits timely initiation of treatment, with low risk of adverse clinical outcomes, based on a retrospective study with a median follow-up period of 4.3 years. These findings indicate that current guidelines for initiating treatment appropriate.