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Published on: February 19, 2019
Characteristics of an outpatient chronic hepatitis B virus infection cohort
Danyenne Rejane de Assis1, Simone de Barros Tenore1, João Renato Rebello Pinho2
1Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Insights
Characterizing chronic hepatitis B patients reveals that active disease is common. Nearly 25% of HBeAg-negative individuals were identified with active hepatitis B through combined DNA and transaminase analysis during follow-up.
Area of Science:
- Hepatology
- Virology
- Clinical Medicine
Background:
- Chronic hepatitis B virus (HBV) infection affects millions globally.
- Accurate patient characterization is crucial for effective management and treatment decisions.
- Longitudinal monitoring is essential for understanding disease progression and identifying active infection.
Purpose of the Study:
- To characterize a cohort of chronic hepatitis B patients.
- To evaluate clinical and laboratory markers for disease activity.
- To identify challenges in diagnosing active hepatitis B during follow-up.
Main Methods:
- Retrospective analysis of clinical and laboratory data from 175 chronic HBsAg-positive adults without HIV or prior treatment.
- Data collected between February 2006 and November 2012 with at least two outpatient visits.
- Statistical analyses included Fisher´s exact test, chi-squared, Wilcoxon, Spearman, multiple comparisons, and Kappa tests.
Main Results:
- The cohort (mean age 42.95±12.53 years) comprised 53.1% men, with 86.9% negative for hepatitis B e-antigen (HBeAg).
- Prevalence of cirrhosis was 8.6% and hepatocellular carcinoma was 1.1%. Genotype A predominated.
- Active hepatitis was observed in 37.7% of patients; 18.3% had persistently elevated HBV DNA with normal ALT, and 9.7% had low HBV DNA with altered ALT. Fifteen cases of active hepatitis would have been missed without follow-up data.
Conclusions:
- Active hepatitis B is prevalent in this cohort.
- Combined analysis of hepatitis B virus DNA and transaminases is vital for detecting active disease, especially in HBeAg-negative patients.
- Clinical follow-up and integrated laboratory data are essential for accurate diagnosis and management of chronic hepatitis B.
Objective:
To characterize a chronic hepatitis B cohort based on initial and follow-up clinical evaluations.
Methods:
A retrospective and descriptive analysis of clinical and laboratory data from chronic HBsAg adult carriers, without HIV, unexposed to treatment, with at least two outpatient visits, between February 2006 and November 2012. Fisher´s exact test, χ², Wilcoxon, Spearman, multiple comparisons and Kappa tests were applied, the level of significance adopted was 5%, with a 95% confidence interval.
Results:
175 patients with mean age of 42.95±12.53 years were included: 93 (53.1%) were men, 152 (86.9%) were negative for hepatitis B e-antigen (HBeAg), 3 (1.7%) had hepatitis C coinfection, 15 (8.6%) had cirrhosis, and 2 (1.1%) had hepatocellular carcinoma. Genotype A predominated. Sixty-six patients (37.7%) had active hepatitis, 6 (3.4%) presented immune tolerance, and 38 (21.7%) were inactive carriers. Exacerbations and/or viral breakthrough were detected in 16 patients (9.1%). In 32 patients (18.3%), hepatitis B virus DNA remained persistently elevated and alanine aminotransferase levels were normal, whereas in 17 (9.7%), there was low hepatitis B virus DNA and alterated alanine aminotransferase. If only initial alanine aminotransferase and hepatitis B virus DNA values were considered, 15 cases of active hepatitis would not have been detected. Advanced fibrosis was more common in HBeAg-positive patients, and it was significantly associated with transaminases, hepatitis B virus DNA, and age.
Conclusion:
Many patients had active hepatitis, but almost 25%, who were HBeAg non-reactive, were only identified because of combined analyses of the hepatitis B virus DNA and transaminases levels, sometimes associated with histological data, after clinical follow-up.
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