台大study就算HBV DNA 小於10000, HBeAg(-), ALT正常，仍有2倍機會HCC或liver cirrhosis

台大在2006年證明HBV DNA > 10000 copies/ml會增加HCC/liver cirrhosis機會
現在看來inactive HBV仍然有問題


Long-Term Outcomes in Carriers of Inactive Hepatitis B Virus

Such carriers are at elevated risk for hepatocellular carcinoma and cirrhosis — and likely require long-term follow-up.

Previous data from a prospective cohort study in Taiwan demonstrated an increased risk for hepatocellular carcinoma (HCC) and cirrhosis among hepatitis B virus (HBV)-infected patients with viral loads ≥10,000 copies/mL (JW Gastroenterol Mar 14 2006 and JW Gastroenterol Jun 13 2006). Now, a report from the same study describes these risks among 1932 carriers of inactive HBV (i.e., nonreplicative HBV infection), compared with 18,137 controls.

By definition, the carriers of inactive HBV met the following criteria at study entry: an HBV DNA level <10,000 copies/mL, a normal serum alanine aminotransferase (ALT) level (<45 U/L), hepatitis B e antigen negativity, and hepatitis B surface antigen (HBsAg) positivity. The controls were all HBsAg negative. Mean follow-up time was 13 years. New HCC cases were identified through a national cancer registry, and liver-related deaths were ascertained through death certificates.

The annual incidence rate of HCC was low overall but significantly higher among carriers than controls (0.6% vs. 0.2%; adjusted hazard ratio, 4.6; 95% confidence interval, 2.5–8.3). A similar pattern was seen for liver-related death (0.04% vs. 0.02%; AHR, 2.1; 95% CI, 1.1–4.1). Among carriers, alcohol use and older age were independent risk factors for incident HCC.

Comment: Traditionally, HBV treatment is considered only for patients with baseline HBV DNA levels ≥10,000 copies/mL. However, these data suggest that patients with normal ALT levels and HBV DNA levels below this threshold also have an elevated risk for HCC and cirrhosis. One important limitation of this study is that it included only baseline HBV DNA levels, not levels during follow-up; thus, patients might not have remained in the inactive carrier state for the duration of the study. Regardless, these results suggest that, at a minimum, carriers of inactive HBV should be followed long term.

— Atif Zaman, MD, MPH

Published in Journal Watch Gastroenterology June 18, 2010
Citation(s):

Chen J-D et al. Carriers of inactive hepatitis B virus are still at risk for hepatocellular carcinoma and liver-related death. Gastroenterology 2010 May; 138:1747.

* Medline abstract (Free)

https://docs.google.com/fileview?id=0B278nGJMQBk7MTVmZjk0MzUtODQwOC00NzgzLTlkNDYtNDU2NGEwZDI2Yjlh&hl=zh_TW

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