LONG-TERM FOLLOW-UP OF HBEAG-POSITIVE PATIENTS TREATED WITH INTERFERON-ALFA FOR CHRONIC HEPATITIS-B

Background, In patients with chronic hepatitis B, treatment with inter feron alfa and the consequent loss of hepatitis B e antigen (HBeAg) fr om the blood leads to a reduction in inflammatory activity, but the cl inical benefits of this treatment have not been established, We evalua ted whether HBeAg seroconversion induced by interferon alfa improves c linical outcome. Methods. We studied prospectively a cohort of 103 pat ients treated with interferon alfa for chronic hepatitis B; the mean ( +/-SD) follow-up was 50.0+/-19.8 months, Fifty-three untreated patient s served as controls. Results. After treatment with interferon alfa, 5 3 of 103 patients no longer had detectable HBeAg or hepatitis B virus DNA, although only 10 patients became seronegative for hepatitis B sur face antigen (HBsAg) (Kaplan-Meier estimates of cumulative clearance r ates at five years, 56.0 percent for HBeAg and 11.6 percent for HBsAg) , Of the 53 untreated patients, only 7 spontaneously eliminated HBeAg (28.1 percent at five years), and all remained positive for HBsAg (P<0 .001 for the comparison with the treated patients, by the proportional -hazards model). During follow-up, 6 of the 103 treated patients died of liver failure, and 2 needed liver transplantation; all 8 were persi stently positive for HBeAg, In another eight treated patients, complic ations of cirrhosis developed; all but one of these patients remained positive for HBeAg, Overall survival and survival without clinical com plications were significantly longer in patients who were seronegative for HBeAg after therapy with interferon alfa than in those who remain ed seropositive (P=0.004 and P=0.018, respectively), In a regression a nalysis, clearance of HBeAg was the strongest predictor of survival, O f the 53 untreated patients, 13 had severe complications (including 4 deaths and 1 need for liver transplantation); all 13 continued to be H BeAg-positive. Conclusions. In patients with chronic hepatitis B infec tion, the clearance of HBeAg after treatment with interferon alfa is a ssociated with improved clinical outcomes. (C) 1996, Massachusetts Med ical Society.