Characteristics of patients with chronic hepatitis B in France: Predominant frequency of HBe antigen negative cases
Introduction
Chronic hepatitis B infection causes a spectrum of different diseases ranging from inactive carrier state to the development of cirrhosis-related complications and hepatocellular carcinoma [1]. Factors determining the clinical outcome in chronic hepatitis B still remain unknown. HBeAg-negative chronic hepatitis B is now recognized as an important form of chronic hepatitis B. It is predominant in the Mediterranean area [2], [3], [4], [5], [6], [7] and the Far East [8], [9]. In most HBeAg-negative patients, HBV infection occurs in childhood as suggested by the high rate of intrafamilial HBV infection, the low rate of parenteral exposure and history of acute hepatitis [4]. The disease runs usually asymptomatic for 30–40 years. However in spite of an intermitting disease profile associated with frequent and sometimes long-lasting remissions, spontaneous recovery is rare and the long-term prognosis is poor with rapid evolution to cirrhosis and hepatocellular carcinoma [3], [4], [5]. In 1994, the frequency of HBeAg-negative chronic hepatitis B was evaluated in France in a prospective study including 276 patients with chronic hepatitis B from 20 University hospitals and was only 22.1% [10]. A majority of patients included in this previous study were born in France or in Northern European countries. Recently, it has been suggested an increase in prevalence of this form of chronic hepatitis B in Southern European countries but also in Northern European countries, leading to a prevalence of 80–90% in Italy or Greece. The aim of the present study was to re-evaluate the frequency of HBeAg-negative chronic hepatitis B in France and to analyze the characteristics in this population of patients.
Section snippets
Patients
Patients were eligible for this study if they had chronic hepatitis B defined as follows: (1) HBsAg positive for at least 6 months, (2) HBe antigen positive or negative, (3) a liver biopsy showing chronic hepatitis lesions with or without cirrhosis. All HBeAg-negative included patients were negative for HBeAg prior to any treatment. Patients with detectable antibodies to human immunodeficiency virus (HIV), hepatitis delta virus (HDV) or hepatitis C virus (HCV), patients without liver biopsy and
Population
Eight hundred and sixty-five patients were included in this study and separated into 2 groups according to HBe status: (1) HBeAg-positive chronic hepatitis B (N = 240), (2) HBeAg-negative chronic hepatitis B (N = 625). Among them 236 were naïve patients and 626 were previously treated by antiviral therapy.
Proportion of HBeAg-negative patients
The overall proportion of HBeAg-negative chronic hepatitis B was 72%. This prevalence was 74.6% in naïve patients and 71.3% in patients who had received previous course(s) of therapy. It was
Discussion
Until recently HBeAg-negative chronic hepatitis B was thought to be relatively rare and largely confined to Asian countries [8], [9], and in the Mediterranean basin [2], [3], [4], [5], [6], [7] than in America or Northern Europe. A prevalence of 80–90% was reported in Italy [6], [12], in Greece [7], [13] and in Asia. In France, in 1994, we reported a prevalence of 22.1% in a population of 276 consecutive patients with chronic hepatitis B seen in University centers. However, recent preliminary
Acknowledgement
The authors thank Dr. Alain Slama (GSK Laboratories) for his technical assistance.
References (30)
- et al.
Outcome of anti-HBe positive chronic hepatitis B in alpha-interferon treated and untreated patients: a long term cohort study
J Hepatol
(2002) - et al.
Hepatitis Be antigen-negative chronic hepatitis B
Hepatology
(2001) - et al.
A randomized controlled trial of a 24-month course of interferon alpha2b in patients with chronic hepatitis B who had hepatitis B virus DNA without hepatitis B e antigen in serum
Hepatology
(1997) - et al.
The long-term outcome of interferon-treated and untreated patients with HBeAg-negative chronic hepatitis B
J Hepatol
(2001) - et al.
Precore and core promoter mutations of hepatitis B virus and hepatitis B e antigen-negative chronic hepatitis B in Korea
J Hepatol
(2003) - et al.
Prevalence of HBV precore/core promoter variants in the United States
Hepatology
(2003) - et al.
Epidemiological data of hepatitis B infection in France: results of nationwide survey
Hepatology
(2003) - et al.
Quantitative serum HBV DNA levels during differents stages of chronic hepatitis B infection
Hepatology
(2002) - et al.
Hepatitis B virus infection. Natural history and clinical consequences
N Engl J Med
(2004) - et al.
World-wide epidemiology of HBeAg-negative chronic hepatitis B and associated precore and core promoter variants
J Viral Hepatol
(2002)