病毒血症
肝硬化
内科学
抗病毒治疗
胃肠病学
医学
病毒学
免疫学
病毒
慢性肝炎
作者
Daniel Q. Huang,Nobuharu Tamaki,Hyung Woong Lee,Soo Young Park,Yu Rim Lee,Hye Won Lee,Seng Gee Lim,Tae-Young Lim,Masayuki Kurosaki,Hiroyuki Marusawa,Toshie Mashiba,Masahiko Kondo,Yasushi Uchida,Haruhiko Kobashi,Koichiro Furuta,Namiki Izumi,Seung Up Kim,Dong Hyun Sinn
出处
期刊:Hepatology
[Wiley]
日期:2023-01-13
卷期号:77 (5): 1746-1756
标识
DOI:10.1097/hep.0000000000000037
摘要
Background: Comparative outcomes of HBV-infected compensated cirrhosis with low-level viremia (LLV) versus maintained virological response (MVR) are unclear. We conducted a large, multiethnic, multicenter study to examine the natural history of LLV versus MVR in compensated cirrhosis. Patients and Methods: We enrolled patients with HBV-infected compensated cirrhosis (n=2316) from 19 hospitals in South Korea, Singapore, and Japan. We defined the LLV group as untreated patients with ≥1 detectable serum HBV-DNA (20–2000 IU/mL), Spontaneous-MVR group as untreated patients with spontaneously achieved MVR, and antiviral therapy (AVT)-MVR group as patients achieving AVT-induced MVR. Study end points were HCC or hepatic decompensation. Results: The annual HCC incidence was 2.7/100 person-years (PYs), 2.6/100 PYs, and 3.3/100 PYs for LLV (n=742), Spontaneous-MVR (n=333), and AVT-MVR (n=1241) groups, respectively ( p = 0.81 between LLV vs. Spontaneous-MVR groups and p = 0.37 between LLV vs. AVT-MVR groups). Similarly, the annual decompensation incidence was 1.6/100 PYs, 1.9/100 PYs, and 1.6/100 PYs for LLV, Spontaneous-MVR, and AVT-MVR groups, respectively ( p = 0.40 between LLV vs. Spontaneous-MVR groups and p = 0.83 between LLV vs. AVT-MVR groups). Multivariable analyses determined that HCC and decompensation risks in the LLV group were comparable to those with Spontaneous-MVR and AVT-MVR groups (all p >0.05). Propensity score matching also reproduced similar results for HCC and decompensation risks (all p >0.05 between LLV vs. Spontaneous-MVR groups and between LLV vs. AVT-MVR groups). Conclusions: Untreated LLV in HBV-infected compensated cirrhosis is not associated with increased risk of disease progression compared with Spontaneous-MVR and AVT-MVR. These data have important implications for practice and further research.
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