Elevated hepatitis B virus core-related antigen levels significantly increased the risk for progression to cirrhosis among patients with chronic hepatitis B who are hepatitis B e antigen-negative and are not receiving nucleos(t)ide analogue therapy, according to recently published data.
“Recently, various indices of liver fibrosis based on clinical and biological data have been reported to be useful predictors of fibrosis in liver disease,” Toshifumi Tada, MD, from the Ogaki Municipal Hospital, Japan, and colleagues wrote. “Our findings suggest that an elevated HBcrAg level should be considered a new criterion for starting antiviral therapy in order to decrease the risk of cirrhosis in HBV carriers.”
From 1991 to 2014, the researchers enrolled 529 hepatitis B surface antigen-positive patients in their hepatocellular carcinoma surveillance program. Patients were HBeAg-negative, not receiving nucleos(t)ide analogue (NA) therapy, had no evidence of hepatitis C coinfection, no other cause of chronic liver disease, and a FIB-4 index score of 3.6 or lower.
During a median follow-up of 10.9 years (range, 6-17.6 years), 84 patients progressed to cirrhosis or a FIB-4 index score higher than 3.6. The cumulative progression rates were 6.6% at 5 years, 12.3% at 10 years, 17.3% at 15 years, and 26.2% at 20 years.
HBcrAg level was the most significant marker for progression to cirrhosis (P < .001), followed by HBsAg level (P = .009), HBV DNA level (P = .025), precore status (P = .039) and basal core promoter status (BCP; P = .044).
After adjusting for HBV genotype, HBsAg levels, HBV DNA levels, HBcrAg levels, precore status and BCP status, HBcrAg levels of 3.7 log U/mL or higher (HR = 3.28; 95% CI, 1.6-6.75) and HBsAg levels of 3 log U/mL or higher (HR = 0.53; 95% CI, 0.3-0.94) remained independently associated with progression to cirrhosis.
“NA therapy was reported not only to prevent the progression of hepatitis, but also to reduce the risk of HCC,” the researchers wrote. “Therefore, NA therapy is recommended for HBeAg seroconverters with elevated HBcrAg levels, even if they have low [alanine aminotransferase] and HBV DNA levels.”
By Talitha Bennett