Extremely low risk of hepatocellular carcinoma development in patients with chronic hepatitis B in immune-tolerant phase

Han Ah Lee, Hyun Woong Lee, In Hee Kim, Soo Young Park, Dong Hyun Sinn, Jung Hwan Yu, Yeon Seok Seo, Soon Ho Um, Jung Il Lee, Kwan Sik Lee, Chang Hun Lee, Won Young Tak, Young Oh Kweon, Wonseok Kang, Yong Han Paik, Jin Woo Lee, Sang Jun Suh, Young Kul Jung, Beom Kyung Kim, Jun Yong ParkDo Young Kim, Sang Hoon Ahn, Kwang Hyub Han, Hyung Joon Yim, Seung Up Kim

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Anti-viral therapy is not indicated for patients with chronic hepatitis B (CHB) in the immune-tolerant phase. Aims: To investigate the cumulative incidence of phase change and hepatocellular carcinoma (HCC) and independent predictors for phase change in patients with CHB in immune-tolerant phase. Methods: In total, 946 patients in immune-tolerant phase, defined as hepatitis B e antigen positivity, HBV-DNA >20 000 IU/mL and alanine aminotransferase (ALT) ≤40 IU/L, between 1989 and 2017 were enrolled from eight institutes. Results: The mean age of study population (429 men and 517 women) was 36.7 years. The mean ALT and HBV-DNA levels were 24.6 IU/L and 8.50 log10 IU/mL, respectively. Of the study population, 476 (50.3%) patients remained in immune-tolerant phase throughout the study period (median: 63.6 months). The cumulative incidence rates of phase change and HCC at 10 years were 70.7% and 1.7%, respectively. Multivariate analyses revealed that HBV-DNA level >107 IU/mL was associated independently with a reduced risk of phase change (hazard ratio [HR] = 0.734, P = 0.008), whereas a high ALT level, above the cut-off recommended in the Korean Association for the Study of the Liver guidelines (34 IU/L for men and 30 IU/L for women), was associated independently with a greater risk of phase change (HR = 1.885, P < 0.001). Conclusions: The criterion of HBV-DNA level > 107 IU/mL may be useful to define immune-tolerant phase. In addition, an extremely low risk of HCC development was observed in patients with CHB in immune-tolerant phase.

Original languageEnglish
Pages (from-to)196-204
Number of pages9
JournalAlimentary Pharmacology and Therapeutics
Volume52
Issue number1
DOIs
Publication statusPublished - 2020 Jul 1

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology
  • Pharmacology (medical)

Fingerprint Dive into the research topics of 'Extremely low risk of hepatocellular carcinoma development in patients with chronic hepatitis B in immune-tolerant phase'. Together they form a unique fingerprint.

  • Cite this

    Lee, H. A., Lee, H. W., Kim, I. H., Park, S. Y., Sinn, D. H., Yu, J. H., Seo, Y. S., Um, S. H., Lee, J. I., Lee, K. S., Lee, C. H., Tak, W. Y., Kweon, Y. O., Kang, W., Paik, Y. H., Lee, J. W., Suh, S. J., Jung, Y. K., Kim, B. K., ... Kim, S. U. (2020). Extremely low risk of hepatocellular carcinoma development in patients with chronic hepatitis B in immune-tolerant phase. Alimentary Pharmacology and Therapeutics, 52(1), 196-204. https://doi.org/10.1111/apt.15741