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Chronic hepatitis B: course and prognosis
Last reviewed: 23.04.2024
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In the world there are more than 300 million carriers of HBV. Consequently, in most patients, the disease should proceed easily and only in some cases it can progress.
The clinical course varies considerably. Many patients remain in a stable, compensated state. This is especially true in asymptomatic cases in cases where a histological examination of the liver reveals a picture of a mild form of chronic hepatitis.
Clinical deterioration in the initially stable HBV carrier can be explained in different ways. The patient can convert from a replicative to an integrated state. This is usually accompanied by remission, which can be constant, with a decrease in the activity of serum enzymes to normal values and an improvement in the histological pattern of the liver; Such a transformation can occur annually in 10-20% of cases.
The prognosis of chronic hepatitis B depends on the severity of the liver disease, which in women usually occurs in a more mild form. Adverse factors are age over 40 years and ascites. Apparently, there are geographical and age specific features during the course of the disease. In Italian children with a positive test for HBV-DNA, the probability of transition to an anti-HBe-positive and HBV-DNA negative state with normalization of serum transaminase activity in childhood is 70%; the probability of the disappearance of HBsAg is 29%. In contrast, on average for 4.0 ± 2.3 years HBsAg disappears only in 2% of healthy carriers or patients with chronic hepatitis, Chinese by origin. In HBeAg-negative patients older than 40 years with developed cirrhosis of the liver, HBsAg disappears more often.
In a study conducted by Italian physicians, in 20% of adults with chronic hepatitis, active cirrhosis developed within 1-13 years. Elderly age, the presence of bridge necrosis from liver biopsy data, the persistence of serum HBV-DNA and HDV-superinfection indicate an unfavorable prognosis.
In general, the prognosis for healthy HBV carriers is good. The 16-year observation of asymptomatic HBV carriers in Montreal showed that they remain asymptomatic and the risk of death from HBV-mediated cirrhosis or hepatocellular carcinoma is small. The frequency of disappearance of HBsAg was 0.7% per year. The prognosis of the disease in Italians - carriers of HBsAg with normal activity of serum transaminases - is also good.
The study of the lethality in the long term among those who fell ill in 1942 during the hepatitis B epidemic in the American army showed a slightly higher incidence of hepatocellular carcinoma. Mortality from non-alcoholic chronic liver disease was lower. Only a few healthy adult males became carriers of HBV.
Infection of HBV-transplanted liver is common in patients with HBV infection, especially with positive tests for HBV-DNA and HBeAg. Retransplantation for recurrent hepatitis B is contraindicated due to high mortality. However, it is possible in HBV-positive patients in whom the transplant failure is of a different genesis.
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