Longitudinal changes in serum HBV DNA levels and predictors of progression during the natural course

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Journal of Viral Hepatitis (OnlineEarly Articles).

doi:10.1111/j.1365-2893.2007.00957.x

Abstract

Longitudinal changes in serum HBV DNA levels and predictors of progression

during the natural course of HBeAg-negative chronic hepatitis B virus infection

G. V. Papatheodoridis, N. Chrysanthos, E. Hadziyannis, E. Cholongitas and E. K.

Manesis Academic Department of Medicine, Hippokration General Hospital of

Athens, Athens, Greece

V. Papatheodoridis MD, Academic Department of Medicine, Hippokration

General Hospital of Athens, 114 Vas. Sophias Ave., 115 27 Athens, Greece.

E-mail: gepapath@...

ALT, alanine aminotransferase; AST, aspartate aminotransferase; CHB, chronic

hepatitis B; CI, confidence interval; HBV, hepatitis B virus; HCC,

hepatocellular carcinoma; HCV, hepatitis C virus; HDV, hepatitis delta virus;

HIV, human immunodeficiency virus; OR, odds ratio; PCR, polymerase chain

reaction; RH, relative hazard; ROC, receiver operating characteristic; ULN,

upper limit of normal.

Abstract

Summary. We evaluated the longitudinal changes of viraemia and predictors of

progression in a prospectively followed cohort of 150 untreated patients with

HBeAg-negative chronic hepatitis B virus (HBV) infection. According to the first

year of follow-up, 85 patients were classified into inactive carrier state and

65 into chronic hepatitis B (CHB). Serum HBV DNA levels were determined at

baseline in all patients, at year-1 in carriers or last pretherapy visit in CHB

patients and during alanine aminotransferase (ALT) elevations in carriers

progressing to CHB. HBV DNA levels at any occasion were ≥80, ≥2000 or ≥20

000 IU/mL in 81%, 23% or 0% of carriers and 100%, 95% or 83% of CHB patients.

The cumulative progression rate from carrier to CHB was 11%, 16%, 24% at 2-, 3-,

4 years and was independently associated with higher baseline ALT (always within

traditional normal range) and baseline HBV DNA ≥2000 or ≥5000 IU/mL. In 12

carriers progressed to CHB, HBV DNA increased by>1 log10 IU/mL. During 7.5

months of median follow-up, HBV DNA change ≥1 log10 IU/mL was observed in 49%

of CHB patients. In conclusion, serum HBV DNA levels are detectable in the

majority of inactive HBV carriers exceeding 2000 IU/mL in only 23% and 20 000

IU/mL in none of them. rs have approximately 15% 3-year risk of

progression to CHB, which is associated with higher baseline ALT and viraemia

≥2000–5000 IU/mL, and thus should be closely followed. Approximately 20% of

HBeAg-negative CHB patients have HBV DNA 1 log10 occurring in many of them.

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