SUMMARY: Older patients and men with chronic hepatitis B virus (HBV) infection were more likely to progress to liver cancer, decompensated cirrhosis, and liver-related death, while Asian patients had lower progression rates, according to an analysis of Kaiser Permanent members presented at the recent American Association for the Study of Liver Diseases "Liver Meeting" (AASLD 2010) in Boston. Diabetes and heavy alcohol use also predicted poor outcomes.

By Liz Highleyman

Over years or decades, chronic hepatitis B can lead to serious liver disease, including cirrhosis, hepatocellular carcinoma (HCC, a form of liver cancer), and liver failure, or decompensation, that requires a transplant or leads to death.

M. Manos and colleagues looked at long-term outcomes among a diverse population of chronic hepatitis B patients in the Kaiser Permanente Medical Care Program, a comprehensive managed care and health insurance system.

This retrospective, longitudinal analysis included nearly 12,000 adult Kaiser Permanent patients with chronic hepatitis B seen for at least 2 consecutive years during 1999-2007. With regards to co-existing conditions, 6% were ever diabetic and 3% had ever had an alcohol abuse diagnosis; individuals with HIV or hepatitis C coinfection were excluded.

Out of a total of 11,932 eligible patients, 10,584 had recorded information about their race/ethnicity. Half were men and the average age at study entry was 43 years. More than 80% were Asian/Pacific Islanders, reflecting that HBV is endemic in many Asian countries and is often transmitted perinatally from mother to child. Most participants (89%) had never been treated for hepatitis B.

Results

	Over a mean follow up period of 50 months, incidence rates for adverse liver-related outcomes were as follows:
	Hepatocellular carcinoma: 0.24 per 100 person years; Decompensated cirrhosis: 0.23 per 100 person years; Liver-related death: 0.19 per 100 person years.
	Higher rates for all outcomes were associated with older age, male sex, diabetes, and history of heavy alcohol use (see table).
	Asian patients were less likely than non-Asians to progress to decompensated cirrhosis or liver-related death (see table).
	While there were not enough treated patients to study the effect of antiviral therapy, models that only included untreated patients produced the same results.
	HCC Decompensation RR RR Age < 50 years 0.17 0.27 Male sex 3.87 3.38 Non-Asian 0.65 1.50 Alcohol diagnosis 2.84 3.80 Diabetes 1.09 3.16  RR: risk ratio adjusted for all factors

"These data suggest that among chronic HBV patients, alcohol contributes to the risk of HCC and both alcohol abuse and diabetes contribute to the risk of decompensation," the Kaiser investigators concluded. "Diabetic and alcoholic chronic HBV patients may benefit from more intensive monitoring of disease progression."

Investigator affiliations: Viral Hepatitis Registry, Kaiser Permanente Division of Research, Oakland, CA, United States.

12/7/10

Reference
M Manos, W Zhao, V Shvachko, and CP Quesenberry. Correlates of Severe Liver Disease Outcomes among Chronic Hepatitis B Patients: a 9-Year Longitudinal Study in a Managed Care Setting. 61st Annual Meeting of the American Association for the Study of Liver Diseases (AASLD 2010). Boston, October 29-November 2, 2010. Abstract 175.