Prognosis of hepatitis B-related liver cirrhosis in the era of oral nucleos(t)ide analog antiviral agents

Chang Ha Kim, Soon Ho Um, Yeon Seok Seo, Jin Yong Jung, Jin Dong Kim, Hyung Joon Yim, Bora Keum, Yong Sik Kim, Yoon Tae Jeen, Hong Sik Lee, Hoon Jai Chun, Chang Duck Kim, Ho Sang Ryu

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Abstract

Background and Aim: We investigated long-term outcomes and prognostic factors in patients with hepatitis B virus (HBV)-related liver cirrhosis in the era of oral nucleos(t)ide analog antiviral agents. Methods: Between January 1999 and February 2009, a total of 240 consecutive patients who had HBV-related cirrhosis without malignancy were treated with lamivudine and second line nucleos(t)ide analogs. The group of historical controls consisted of 481 consecutive patients with HBV-related cirrhosis who were managed without any antiviral treatment prior to 1999. Results: In 78% of the patients who received antiviral treatment, sustained viral suppression (serum HBV DNA <105 copies/mL) was achieved during a mean follow-up period of 46months. The occurrences of death, hepatic decompensation, and hepatocellular carcinoma (HCC) were less frequent in the treated cohort than in untreated historical controls, with the 5-year cumulative incidences being 19.4% versus 43.9% (log-rank P<0.001), 15.4% versus 45.4% (P=0.001), and 13.8% versus 23.4% (P=0.074), respectively. For patients who received antiviral treatment, suboptimal viral suppression (HBV DNA >105 copies/mL at last follow-up) was an important independent risk factor of death (P<0.001) and hepatic decompensation (P=0.019), and was linked to an increased risk of HCC (P=0.042). Although the Child-Pugh grade remained a useful prognostic factor, no significant differences were found between patients with Child-Pugh grade B and C cirrhosis at the beginning of antiviral treatment (P=0.656). Conclusions: Oral antiviral agents have improved the prognosis of patients with HBV-related cirrhosis and affected the prognostic values of factors constituting the Child-Pugh system, necessitating a more efficient prognostic system.

Original languageEnglish
Pages (from-to)1589-1595
Number of pages7
JournalJournal of Gastroenterology and Hepatology (Australia)
Volume27
Issue number10
DOIs
Publication statusPublished - 2012 Oct

Keywords

  • Hepatitis B-related liver cirrhosis
  • Lamivudine
  • Oral antiviral agent
  • Prognosis

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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  • Cite this

    Kim, C. H., Um, S. H., Seo, Y. S., Jung, J. Y., Kim, J. D., Yim, H. J., Keum, B., Kim, Y. S., Jeen, Y. T., Lee, H. S., Chun, H. J., Kim, C. D., & Ryu, H. S. (2012). Prognosis of hepatitis B-related liver cirrhosis in the era of oral nucleos(t)ide analog antiviral agents. Journal of Gastroenterology and Hepatology (Australia), 27(10), 1589-1595. https://doi.org/10.1111/j.1440-1746.2012.07167.x