Conflict of interest: Nothing to disclose.
Prognosis of hepatitis B-related liver cirrhosis in the era of oral nucleos(t)ide analog antiviral agents
Version of Record online: 19 SEP 2012
© 2012 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd
Journal of Gastroenterology and Hepatology
Volume 27, Issue 10, pages 1589–1595, October 2012
How to Cite
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. and 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, 27: 1589–1595. doi: 10.1111/j.1440-1746.2012.07167.x
- Issue online: 19 SEP 2012
- Version of Record online: 19 SEP 2012
- Accepted manuscript online: 3 MAY 2012 11:06AM EST
- Accepted for publication 5 April 2012.
- hepatitis B-related liver cirrhosis;
- oral antiviral agent;
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 46 months. 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.