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Clinical and Translational Gastroenterology, 2020.11, pe00140-0, DOI: https://doi.org/10.14309/ctg.0000000000000140
Natural History of Untreated HBeAg-Positive Chronic HBV Infection With Persistently elevated HBV DNA but Normal Alanine Aminotransferase
Hye Won Lee,
OBJECTIVES: Nucleos(t)ide analogues (NUCs) are not routinely recommended for patients with hepatitis B e antigen–positive chronic hepatitis B virus (HBV) infection who have persistently elevated serum HBV DNA level (>20,000 IU/mL) but normal alanine aminotransferase (<40 IU/L) level. Here, we evaluated the cumulative risks of hepatocellular carcinoma (HCC) in such patients (the untreated persistently elevated serum HBV DNA [pEDNA] group) compared with inactive carriers (the IC group).
METHODS: Patients with untreated pEDNA (n 5 126) and IC (n 5 621) were enrolled between 2006 and 2012. Patients with cirrhosis or HCC at enrollment or a history of NUC treatment were excluded.
RESULTS: The cumulative HCC risks at 5 and 9 years in the untreated pEDNA group were 1.1% and 1.9%, which were comparable with those of the IC group (P50.549). Inverse probability of treatment weighting and propensity score matching also showed similar HCC risks. In the untreated pEDNA group, there were no cases of HCC in the subgroup with serum HBV DNA level >1,000,000 IU/mL (immune-tolerant phase), which was significantly (P 5 0.002) different compared with those with an intermediate serum HBV DNA level (20,000–1,000,000 IU/mL).
DISCUSSION: The cumulative HCC risk in the untreated pEDNA group was minimal and comparable with that of the IC group. Further studies are required to determine whether early NUC treatment, indeed, reduces the HCC risk in patients with an intermediate serum HBV DNA level.
- DOI: https://doi.org/10.14309/ctg.0000000000000140
- ISBN or ISSN: 2155-384X
- 본 연구는 질병관리본부 연구개발과제연구비를 지원받아 수행되었습니다.
- This research was supported by a fund by Research of Korea Centers for Disease Control and Prevention.