Abstract
The aim of this study was to assess the long-term prognosis of chronic hepatitis B infection, focusing on progression to cirrhosis and hepatocellular carcinoma (HCC) and survival. A total of 88 Japanese patients who were positive for hepatitis B surface antigen (HBsAg) were followed for 6 to 247 months. All were diagnosed as having chronic hepatitis by needle biopsy. Of the 67 patients (76.1%) who were positive for hepatitis B e antigen ( HBeAg), 50 received interferon (IFN) therapy of which 45 seroconverted from HBeAg to HBe antibody ( anti-HBe) . There was a significant difference in the rate of seroconversion between IFN-treated and untreated patients (p=0.039) . During the follow-up, progression to cirrhosis occurred in 12, liver failure in 5, HCC in 6 and five patients died (4 from hepatic causes and 1 from a non-hepatic cause) . Multivariate analysis indicated that both high HBVDNA polymerase (DNA-p) activity (p=0.036) and advanced hepatic fibrosis (p=0.033) contribute to cirrhosis, with advanced hepatic fibrosis (p=0.023) contributing to HCC, and high DNA-p activity being associated with liver failure (p=0.048) and death (p=0.042) . In the present study, we determined that the disappearance of HBeAg was frequently observed, but in sharp contrast disappearance of HBsAg was rarely found. The long-term prognosis of chronic hepatitis B could be independently predicted by advanced hepatic fibrosis and high levels of DNA-p activity. A poor prognosis was linked to the presence of cirrhosis and persistent HBV replication leading to an increased risk of death.
