Hepatitis B infection and liver cirrhosis: A reappraisal from the mediterranean area

A. Craxi, P. Colombo, G. D'Amico, F. Di Blasi, V. Di Marco, S. Magrin, S. Maisano, F. Politi, I. Scalisi, G. Spinelli, F. Tine, M. Traina, R. Vassallo, M. Vinci, G. Vizzini, R. Virdone, L. Pagliaro

Research output: Contribution to journalArticlepeer-review

Abstract

The clinical usefulness of immunological and molecular markers of hepatitis B (HBV) and hepatitis delta virus (HDV) infection in predicting the course and outcome of chronic HBsAg positive liver disease as it presents in the Mediterranean area, wherein the infection spreads mostly during infancy through intrafamilial contacts, is as yet largely conjectural. In fact most of the available data have been derived from studies in selected groups of Western European or U.S. subjects whose infection has been acquired in the adult age by homosexual contact or parenteral exposure. We have investigated a large sample of patients from Southern Italy with HBeAg positive chronic liver disease, with or without HDV superinfection, at their clinical presentation, in order to define the natural history of the condition and assess the value of a set of clinical and laboratory variables, including the above replicative markers, as predictors of the disease course. Here reported are the results of an ad interim analysis. Our study included enough patients to provide reliable estimates of survival and of the rate of deterioration, defined as the occurrence of 'hard' outcome events (death, hepatic decompensation, development of cancer). Chronic HBV-induced liver disease turned out to be, over a medium-term period, a rather indolent condition, mostly asymptomatic at presentation and with a low trend to worsening. No clinical or laboratory features were able to differentiate accurately among the various types of disease. Presence of complete HBV replication and/or active HDV superinfection did not alter significantly the course, while the finding of cirrhosis on first biopsy was a major factor in predicting a worse outcome. Multivariate analysis of the selected putative predictors indicated age and serum albumin at presentation as the best predictors of outcome. Further follow-up is in progress in order to evaluate the prognostic value of all indexes over a long-term follow-up.

Original languageEnglish
Pages (from-to)257-265
Number of pages9
JournalAnnali dell'Istituto Superiore di Sanita
Volume24
Issue number2
Publication statusPublished - 1988

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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