Gastroenterology

Gastroenterology

Volume 123, Issue 6, December 2002, Pages 1848-1856
Gastroenterology

Clinical–Liver, Pancreas, and Biliary Tract
Influence of hepatitis B virus genotype on the long-term outcome of chronic hepatitis B in western patients,☆☆

https://doi.org/10.1053/gast.2002.37041Get rights and content

Abstract

Background & Aims: The aim of this study was to investigate if the variable outcome of chronic hepatitis B may be related to hepatitis B virus (HBV) genotype. Methods: The clinical and virologic events observed over prolonged follow-up in 258 Spanish patients with chronic hepatitis B infected with different genotypes of HBV were compared. Results: The prevalence of genotype A, D, and F was 52%, 35%, and 7%, respectively. Concomitant sustained biochemical remission and clearance of HBV DNA occurred at a higher rate in genotype A– than in genotype D– (log-rank, 14.2; P = 0.002) or genotype F–infected patients (log-rank, 4.2; P = 0.03). The rate of hepatitis B surface antigen (HBsAg) clearance was higher in genotype A than in genotype D hepatitis (log-rank, 4.6; P = 0.03). Sustained remission and clearance of HBsAg were associated with infection with genotype A by Cox regression analysis. Seroconversion to antibody to hepatitis B e antigen (anti-HBe) was unrelated to HBV genotype, but the rate of sustained remission after seroconversion was higher in genotype A than in genotype D hepatitis both in patients who seroconverted to anti-HBe during follow-up (log-rank, 4.5; P = 0.03) and in patients with positive anti-HBe at baseline (log-rank, 6.66; P = 0.009). Death related to liver disease was more frequent in genotype F than in genotype A (P = 0.02) or genotype D (P = 0.002) hepatitis. Conclusions: The long-term outcome of chronic hepatitis B is different in patients infected with HBV genotype A, D, or F.

GASTROENTEROLOGY 2002;123:1848-1856

Section snippets

Patients

From January 1985 to January 1998, 407 Spanish patients with asymptomatic or minimally symptomatic chronic hepatitis B were consecutively referred to the Liver Unit of the Hospital Clinic of Barcelona, Spain. All had a persistent or intermittent elevation of alanine aminotransferase serum levels and a positive test for hepatitis B surface antigen (HBsAg) in serum for at least 6 months, but none had past or current hepatic decompensation. Patients with evidence of infection with hepatitis C

Features at the time of diagnosis

The main features at presentation of the 269 patients included in the study are summarized in Table 1.Serum HBV DNA was detected in all of the patients, either at baseline (220 cases) or during follow-up (49 cases, all positive for anti-HBe). HBV genotype was identified in 254 cases (94%): genotype A in 140 (52%), genotype D in 94 (35%), and genotype F in 20 (7%). Other genotypes were not identified, and the PCR/restriction fragment length polymorphism assay was not conclusive in 15 cases (6%).

Discussion

Several circumstances, including environmental, host, and HBV-related factors, have been recognized as important determinants of the highly variable outcome of chronic HBV infection. However, information concerning the possible role of HBV genotype on the natural history of this disease is rather limited. Previous cross-sectional studies provided controversial data,15, 16, 17, 18 and only a longitudinal survey concerning Chinese patients with HBV genotype B or C infection has been reported thus

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    Supported in part by a grant from Ministerio de Educación y Cultura (SAF 2000-0048).

    ☆☆

    Address requests for reprints to: José M. Sánchez-Tapias, M.D., Liver Unit, Hospital Clinic, Villarroel 170, 08036 Barcelona, Spain. e-mail: [email protected]; fax: (34) 93-451-5522.

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