Prognosis of Hepatitis B inactive carriers

2017-06-30

In a prospective cohort study from Japan hepatitis B inactive carriers were followed from 2011 to 2015. The definition of an inactive carrier was ALT below 31 u/L (0.53μkat/L) and HBV-DNA below 4 log copies/mL and negative HBeAg. Baseline blood tests and elastography was performed in all patients and routine surveillance with α-fetoprotein and abdominal imaging was performed every 6 to 12 months. 388 patients from 18 Japanese centers met the inclusion criteria and were included in the study. Median age at inclusion was 57.5 years. The mean follow up time was 1035 days. No patient developed hepatocellular cancer (HCC) or signs of cirrhosis. 75 patients (19.3 %) deviated from the definition of inactive carrier during the study by either a HBV-DNA level above 4 log or ALT higher than 31 u/L. Factors associated with deviation from the inactive carrier state included higher baseline HBV-DNA, higher ALT, younger age (54 vs 58), higher γ-GTP and HBsAg titer. By combining low levels of ALT, γ-GTP, HBV-DNA and HBsAg titer constant inactive carrier state could be predicted.

Taida et al. J Gastroenterol 2017:52:113-122

Comment: The majority of patients with chronic hepatitis B infection are HBeAg negative and have HBV-DNA less than 4 log. It is unclear how often and how these patients should be optimally monitored. As shown in this study, the prognosis is usually good and the development of cirrhosis or HCC is fortunately rare though there still is an increased risk compared to the noninfected population. Is it possible to define a subgroup of patients that do not need to be monitored at all by combining a panel of favorable laboratory parameters? It is perhaps possible to do, but we need larger studies with longer follow up before any conclusions can be drawn.