The Prognosis of Hepatitis B-related Liver Cirrhosis in the Era of Oral Nucleos(t)ide analogue Antiviral Agents

Journal of Gastroenterology and Hepatology, 05/15/2012

Oral antiviral agents have improved the prognosis of patients with hepatitis B virus (HBV)–related cirrhosis and affected the prognostic values of factors constituting the Child–Pugh system, necessitating a more efficient prognostic system.

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 analogues.
  • 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% vs. 43.9% (log-rank p<0.001), 15.4% vs. 45.4% (p=0.001), and 13.8% vs. 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).

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