Outcome of anti-HBe positive chronic hepatitis B in alpha-interferon treated and untreated patients: A long term cohort study

Background/Aims: We studied the influence of biochemical and virologic patterns and interferon on the outcome of anti-HBe positive chronic hepatitis B in 164 (103 treated) consecutive patients, followed-up prospectively for a mean of 6 years (21 months-12 years). Methods: Histology, biochemical and virologic profiles were characterized by monthly monitoring during the first 12 months of follow-up. Thereafter patients underwent blood and clinical controls every 4 and 6 months, respectively. Cirrhosis at follow-up histology or end stage complications of cirrhosis served as end points for the analysis of factors influencing disease progression in patients with baseline chronic hepatitis or cirrhosis, respectively. Results: Disease progression was associated with older age (P <0.001), absence of previous HBeAg history (P = 0.017) and higher serum HBV-DNA levels (P = 0.009) (more frequently observed in unremitting disease profile, P = 0.012) at multivariate analysis. Fluctuations of IgM anti-HBc levels (associated with disease exacerbations, P = 0.045) correlated with end stage complications in cirrhotics (P = 0.011). Disease improved in 14.6 and 1.6% of treated and untreated patients, respectively (P = 0.015): interferon slowed disease progression (P <0.001). Conclusions: The outcome of anti-HBe positive chronic hepatitis B is worsened by older age and persistent viral replication or hepatitis exacerbations in chronic hepatitis or in cirrhotic patients, respectively. Interferon reduces by 2.5-folds disease progression.