The Brazilian Journal of Infectious Diseases The Brazilian Journal of Infectious Diseases
Braz J Infect Dis 2017;21:441-7 - Vol. 21 Num.4 DOI: 10.1016/j.bjid.2017.03.019
Original article
Retrospective analysis of hepatitis B virus chronic infection in 247 patients: clinical stages, response to treatment and poor prognostic factors
Marlone Cunha-Silvaa,, , Fábio R.T. Marinhoa, Paulo F. Oliveirab, Tirzah M. Lopesa, Tiago Sevá-Pereiraa, Sonia L.S. Lorenaa, Jazon R.S. Almeidaa
a Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Gastroenterologia, Campinas, SP, Brazil
b Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Bioestatística, Campinas, SP, Brazil
Received 06 December 2016, Accepted 30 March 2017
Abstract
Background

Chronic hepatitis B is a major cause of cirrhosis, and the natural history of the disease has several clinical stages that should be thoroughly understood for the implementation of proper treatment. Nonetheless, curing the disease with antiviral treatment remains a challenge.

Aims

To describe the clinical course, response to treatment, and poor prognostic factors in 247 hepatitis B virus chronic infection patients treated in a tertiary hospital in Brazil.

Methods

This was a retrospective and observational study, by analyzing the medical records of HBV infected patients between January 2000 and January 2015.

Results

Most patients were male (67.2%) and 74.1% were HBeAg negative. Approximately 41% had cirrhosis and 8.5% were hepatitis C virus coinfected. The viral load was negative after two years on lamivudine, entecavir and tenofovir in 86%, 90.6%, and 92.9% of the patients, respectively. The five-year resistance rates for lamivudine, adefovir, entecavir, and tenofovir were 57.5%, 51.8%, 1.9%, and 0%, respectively. The overall seroconversion rates were 31.2% for HBeAg and 9.4% for HBsAg. Hepatocellular carcinoma was diagnosed in 9.7% of patients, liver transplantation was performed in 9.7%, and overall mortality was 10.5%. Elevations of serum alanine aminotransferase (p=0.0059) and viral load (p<0.0001) were associated with progression to liver cirrhosis. High viral load was associated with progression to hepatocellular carcinoma (p<0.0001). Significant risk factors associated with death were elevated alanine aminotransferase (p=0.0039), liver cirrhosis (p<0.0001), high viral load (p=0.007), and hepatocellular carcinoma (p=0.0008). HBeAg positive status was not associated with worse outcomes, and treatment may have been largely responsible.

Conclusions

Elevations of viral load and serum alanine aminotransferase may select patients with worse prognosis, especially progression to cirrhosis and hepatocellular carcinoma, which were strongly association with death.

Keywords
Hepatitis B, Clinical stages, Treatment, Liver cirrhosis, Hepatocellular carcinoma
Braz J Infect Dis 2017;21:441-7 - Vol. 21 Num.4 DOI: 10.1016/j.bjid.2017.03.019