The long-term course of chronic hepatitis B

The aim of this study was to assess the long-term outcome in hepatitis B vi rus (HBV)-infected patients according to HBV, hepatitis C virus (HCV), and hepatitis D virus (HDV) replication, focusing on survival, liver failure, a nd hepatocellular carcinoma (HCC). A cohort of 302 hepatitis B surface anti gen (HBsAg)-positive subjects (mean age, 34 +/- 15.3 years; male/female 214 /88; 39 subjects under 14 years) with biopsy-proven chronic hepatitis (86 w ith cirrhosis) was prospectively assessed, with a median follow-up of 94 +/ - 37.6 months. One hundred nine patients received interferon alfa (IFN). At baseline, 86 subjects (28.5%) were hepatitis B e antigen (HBeAg)-positive (wild-type HBV), 80 (26.5%) were HBeAg-negative, HBV-DNA-positive, 76 (25.2 %) had HDV infection, 43 (14.2%) had dual HBV/HCV infection, and 17 (5.6%) were negative for HBV-DNA, anti-HCV and anti-HDV. During follow-up, decompe nsation of disease occurred in 46 subjects: 8 developed HCC, 36 developed a scites, and 2 developed jaundice. Five patients underwent transplantation. Thirty-five subjects died: 33 of hepatic and 2 of nonhepatic causes. Overal l mortality was 5.2-fold that of the general population (95% CI: 3.6-7.3; 3 5 deaths observed, 6.7 expected; P < .0001), By Cox regression analysis, su rvival was independently predicted by young age, absence of cirrhosis at ba seline, and sustained normalization of aminotransferases during follow-up. Survival without decompensation was independently predicted by the same fac tors and by IFN treatment. Chronic hepatitis B infection increases mortalit y in comparison with the general population in our area regardless of speci fic virological profiles at presentation. Presence of cirrhosis and persist ent necroinflammation markedly increase the risk of death.