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Risk factors for active liver disease in HBeAg-negative chronic hepatitis B virus-infected patients
1Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin.
Insights
Hepatitis B virus (HBV) relapse risk is lower in HBeAg-negative patients with normal ALT levels. Elevated ALT and male gender independently predict higher relapse risk in these chronic HBV carriers.
Area of Science:
- Hepatology
- Virology
- Internal Medicine
Background:
- Hepatitis B e antigen (HBeAg)-negative patients represent a significant portion of chronic hepatitis B virus (HBV) infections, particularly in Southeast Asia.
- A subset of these patients experiences active disease despite being HBeAg-negative.
Purpose of the Study:
- To investigate the risk of hepatitis relapse in chronic HBV-infected patients who are HBeAg-negative.
- To identify predictors associated with hepatitis relapse in this specific patient group.
Main Methods:
- Retrospective analysis of HBsAg-positive, HBeAg-negative patients with over 12 months of follow-up and at least three blood samples.
- Analysis of demographic data, liver biochemistry (ALT), and HBV serology to determine relapse predictors.
- Relapse defined as ALT > 200 IU/L or > 3-fold previous levels.
Main Results:
- 317 patients were analyzed, with a median follow-up of 34 months. 18% experienced at least one relapse.
- Elevated ALT at first presentation (OR 4.17) and male gender (OR 2.83) were independent predictors of relapse.
- A single ALT test showed 64.9% sensitivity and 71.5% specificity for predicting relapse.
Conclusions:
- Chronic HBV carriers who are HBeAg-negative and have normal ALT levels exhibit a low risk of hepatitis relapse.
- Identifying patients at higher risk through baseline ALT and gender can inform monitoring strategies.
Objectives:
HBeAg-negative patients constitute approximately 70% of all chronic hepatitis B virus (HBV) infections in Southeast Asia, and some of these patients continue to suffer from active disease. We aimed to study the risk of hepatitis relapse in chronic HBV-infected patients with negative HBeAg and the predictor(s) of relapses.
Methods:
This was a retrospective analysis of patients carrying HBsAg but lacking HBeAg. Patients recruited were required to have been followed for > or = 12 months with a minimum of three blood samples available for analysis. Patient demographic data, liver biochemistry, and HBV serology were analyzed in relation to relapses of hepatitis. Relapse was defined as an abrupt elevation of ALT > 200 IU/L or > 3-fold previous levels, whichever was higher.
Results:
In a period of 3 months, 317 patients seen at the Hepatitis Clinic at the Prince of Wales Hospital in Hong Kong were recruited. The median duration of follow-up was 34 months. On initial consultation, 111 (35.0%) patients had elevated ALT (>60 IU/L). Overall, 57 (18.0%) patients developed at least one relapse, including 37 (33.3%) patients with elevated ALT and 20 (9.7%) patients with normal ALT at the first visit. Multiple logistic regression analysis showed that elevated ALT level at first presentation (odds ratio 4.17, 95% confidence interval 2.24-7.75) and male gender (odds ratio 2.83, 95% confidence interval 1.23-6.49) were the two independent factors associated with a higher risk of hepatitis relapse. The sensitivity, specificity, and positive and negative predictive values of a single ALT test for hepatitis relapse were 64.9%, 71.5%, 33.3%, and 90.3%, respectively.
Conclusions:
HBeAg-negative HBV carriers with normal ALT levels have a low risk of hepatitis relapse.