Progression to cirrhosis, hepatocellular carcinoma and liver-related mortality in chronic hepatitis B patients in Italy.

BACKGROUND: The natural history of chronic hepatitis B is variable. We evaluated some of the risk factors for cirrhosis, hepatocellular carcinoma and liver-related mortality in Italian patients with chronic hepatitis B.
METHODS: A cohort of 105 untreated patients with chronic hepatitis B without cirrhosis at diagnosis was followed prospectively for a mean period of 23 years.
Clinical, histological and ultrasound examinations, biochemical and virologicaltests, and causes of death were analyzed.
RESULTS: Forty-two (40%) patients became inactive carriers and 63 (60%) showed
persistent alanine aminotransferase elevation: 13 (13%) associated with HBeAg
persistence, 35 (33%) with detectable serum HBV-DNA but HBeAg-negative, 11 (10%)
with concurrent virus infection and 4 (4%) with non-alcoholic fatty liver disease. Cirrhosis incidence was 1.56/100 person-years. Older age and sustained HBV replication predicted cirrhosis occurrence independently. Hepatocellular
carcinoma incidence was 2.1/100 person-years in patients who developed cirrhosis and 0.06 in those who did not. Cirrhosis occurrence was associated with an increased risk of hepatocellular carcinoma (hazard ratio 20.4, 95% confidence
interval 2.54-167.5) and liver-related death (16.5, 2.0-138.8).
CONCLUSIONS: In Italian patients with chronic hepatitis B cirrhosis strongly predicts hepatocellular carcinoma occurrence and disease-related mortality, thus indicating that early antiviral treatment should be instituted before cirrhosis
occurrence.