The development of cirrhosis in patients with chronic type B hepatitis: A prospective study

TLDR

The study prospectively evaluated cirrhosis incidence and risk factors in 684 chronically HBV‑B patients, including 509 HBeAg‑positive and 175 anti‑HBe‑positive individuals. During a mean 35.3‑month follow‑up, cirrhosis developed in 35 HBeAg‑positive and 7 anti‑HBe‑positive patients (annual incidences of 2.4% and 1.3%), with incidence rising with age and being markedly higher in patients who had hepatic decompensation, repeated severe acute exacerbations, or HBV reactivation, while delta superinfection and chronic active hepatitis did not increase risk.

Abstract

The incidence and contributing factors of cirrhosis developing in patients with chronic type B hepatitis were assessed prospectively in 684 clinicopathologically verified patients, of which 509 were HBeAg positive and 175 were anti-HBe positive at entry into the study. During an average follow-up period of 35.3 months, cirrhosis occurred 6 to 64 months after entry in 35 HBeAg-positive and 7 anti-HBe positive patients with a calculated annual incidence of 2.4 and 1.3%, respectively (p > 0.05). The incidence increased significantly with the increasing age at entry. Patients who had experienced (a) hepatic decompensation, (b) repeated episodes of severe acute exacerbation (with α-fetoprotein > 100 ng per ml and/or bridging hepatic necrosis), (c) severe acute exacerbation not accompanied by subsequent HBeAg seroconversion and (d) hepatitis B virus reactivation (particularly those with HBeAg reappearance) were found to develop cirrhosis much more frequently (p < 0.001). Contrary to general belief, patients who had hepatitis delta virus superinfection and patients with chronic active hepatitis were not particularly prone to develop cirrhosis. We conclude that in addition to age factor, the extent, severity, duration, frequency and etiology of the hepatic lobular alterations are important factors for the development of cirrhosis in patients with chronic type B hepatitis.