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- Title
Prognosis of hepatitis B-related liver cirrhosis in the era of oral nucleos(t)ide analog antiviral agents.
- Authors
Kim, Chang Ha; Um, Soon Ho; Seo, Yeon Seok; Jung, Jin Yong; Kim, Jin Dong; Yim, Hyung Joon; Keum, Bora; Kim, Yong Sik; Jeen, Yoon Tae; Lee, Hong Sik; Chun, Hoon Jai; Kim, Chang Duck; Ryu, Ho Sang
- Abstract
Background and Aim: We investigated long-term outcomes and prognostic factors in patients with hepatitis B virus (HBV)-related liver cirrhosis in the era of oral nucleos(t)ide analog antiviral agents. Methods: Between January 1999 and February 2009, a total of 240 consecutive patients who had HBV-related cirrhosis without malignancy were treated with lamivudine and second line nucleos(t)ide analogs. The group of historical controls consisted of 481 consecutive patients with HBV-related cirrhosis who were managed without any antiviral treatment prior to 1999. Results: In 78% of the patients who received antiviral treatment, sustained viral suppression (serum HBV DNA < 105 copies/mL) was achieved during a mean follow-up period of 46 months. The occurrences of death, hepatic decompensation, and hepatocellular carcinoma (HCC) were less frequent in the treated cohort than in untreated historical controls, with the 5-year cumulative incidences being 19.4% versus 43.9% (log-rank P < 0.001), 15.4% versus 45.4% ( P = 0.001), and 13.8% versus 23.4% ( P = 0.074), respectively. For patients who received antiviral treatment, suboptimal viral suppression (HBV DNA > 105 copies/mL at last follow-up) was an important independent risk factor of death ( P < 0.001) and hepatic decompensation ( P = 0.019), and was linked to an increased risk of HCC ( P = 0.042). Although the Child-Pugh grade remained a useful prognostic factor, no significant differences were found between patients with Child-Pugh grade B and C cirrhosis at the beginning of antiviral treatment ( P = 0.656). Conclusions: Oral antiviral agents have improved the prognosis of patients with HBV-related cirrhosis and affected the prognostic values of factors constituting the Child-Pugh system, necessitating a more efficient prognostic system.
- Subjects
CIRRHOSIS of the liver; HEPATITIS B virus; NUCLEOSIDES; ANTIVIRAL agents; LAMIVUDINE; PROGNOSIS
- Publication
Journal of Gastroenterology & Hepatology, 2012, Vol 27, Issue 10, p1589
- ISSN
0815-9319
- Publication type
Article
- DOI
10.1111/j.1440-1746.2012.07167.x