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Varying Disease Progression Among Patients With Chronic Hepatitis B
Disease progression in patients with chronic hepatitis B (CHB) varies greatly, including within “lower risk” populations, recent research reveals.
The study included the authors’ recommendation that future CHB modeling studies, public health planning, and hepatocellular carcinoma (HCC ) surveillance recommendations be based on more precise disease progression rates, including the patient’s age, sex, disease activity, and treatment status.
“Antiviral treatment criteria are based on disease progression risk, and HCC surveillance recommendations for patients with CHB without cirrhosis is based on an annual incidence threshold of 0.2%. However, accurate and precise disease progression estimate data are limited. Thus, we aimed to determine rates of cirrhosis and HCC development stratified by age, sex, treatment status, and disease activity based on the 2018 AASLD and 2017 EASL guidelines,” the authors reported.
Research included data from 18,338 patients—8914 treated and 9424 untreated—from 6 US centers, and 27 centers from Asia Pacific countries, utilizing the Kaplan-Meier method in estimating annual progression rates to cirrhosis or HCC. Within the study, 63% of patients were men, with an average age of 46 years, baseline cirrhosis of 14.3%, and an average follow-up duration of 9.6 years.
“There is great variability in CHB disease progression rates,” the authors reported. “By AASLD criteria, depending on age, sex, and disease activity, annual incidence rates ranged from 0.07%-3.94% for cirrhosis; 0.04%-2.19% for HCC in patients without cirrhosis; and 0.40%-8.83% for HCC in patients with cirrhosis. Several subgroups of patients without cirrhosis, including males younger than 40 and females younger than 50, had annual HCC risk near or exceeding 0.2%. Similar results were found using EASL criteria,” the authors concluded.
—Angelique Platas
Reference
Park J, Le AK, Tseng TC, Kao JH, Yang HI, Nguyen MH. Progression rates by age, sex, treatment, and disease activity by AASLD and EASL criteria: data for precision medicine. Clin Gastroenterol Hepatol. Published online June 1, 2021.
