Clinical outcomes in adults with chronic hepatitis B in association with patient and viral characteristics: A systematic review of evidence

Authors

  • Brent C. Taylor,

    Corresponding author
    1. Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MN
    2. Department of Medicine, University of Minnesota, Veterans Affairs Medical Center, Minneapolis, MN
    3. Minnesota Evidence-Based Practice Center, Minneapolis, MN
    4. Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN
    • Center for Chronic Disease Outcomes Research (111-0), Minneapolis VA Medical Center, 1 Veterans Drive, Minneapolis MN 55417
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    • fax: 612-725-2118.

  • Jian-Min Yuan,

    1. Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN
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  • Tatyana A. Shamliyan,

    1. Minnesota Evidence-Based Practice Center, Minneapolis, MN
    2. Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN
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  • Aasma Shaukat,

    1. Department of Medicine, University of Minnesota, Veterans Affairs Medical Center, Minneapolis, MN
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  • Robert L. Kane,

    1. Minnesota Evidence-Based Practice Center, Minneapolis, MN
    2. Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN
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  • Timothy J. Wilt

    1. Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MN
    2. Department of Medicine, University of Minnesota, Veterans Affairs Medical Center, Minneapolis, MN
    3. Minnesota Evidence-Based Practice Center, Minneapolis, MN
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  • Potential conflict of interest: Nothing to report.

  • Disclaimer: The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

Abstract

We systematically reviewed the literature on the extent to which population characteristics or clinical features predict groups of individuals likely to develop advanced liver disease or die from chronic infection with hepatitis B virus (HBV). We searched Medline to include studies with reported cirrhosis, liver failure, liver cancer, or death outcomes after at least 1 year of follow-up from the measurement of predictive factors (age, age at infection, geographic location, race/ethnicity, sex, positive family history, presence of coinfections, HBV viral level, change in hepatitis B e antigen [HBeAg] status, genotype, HBV mutations, nonalcoholic fatty liver disease, alcohol consumption, liver enzymes, and liver biopsy finding). Evidence from 41 included articles suggested that cirrhosis, higher HBV viral level, and male sex were consistently associated with significantly increased risk of death and liver cancer. Evidence about the role of HBV genotype, HBeAg status, age and duration of infection, coinfections with hepatitis C virus, human immunodeficiency virus, hepatitis delta virus, and alanine aminotransferase levels were limited and inconsistent, but were deemed promising to identify patients at higher risk of clinical outcomes. Adults with chronic hepatitis B had increased risk for poorer health outcomes compared to the general population; however, the magnitude of risk varied greatly depending on baseline patient and disease characteristics, and typically clinical outcomes required many years to become manifest. Many adults with chronic hepatitis B had low absolute risks of clinical outcomes and likely would not benefit from immediate treatment. Baseline patient and disease characteristics provide important information about the risk of clinical outcomes and should be incorporated into monitoring or treatment decisions. (HEPATOLOGY 2009;49:S85–S95.)

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