Elsevier

Journal of Hepatology

Volume 45, Issue 3, September 2006, Pages 355-360
Journal of Hepatology

Characteristics of patients with chronic hepatitis B in France: Predominant frequency of HBe antigen negative cases

https://doi.org/10.1016/j.jhep.2006.03.007Get rights and content

Background/Aims

An increasing prevalence of HBe antigen (HBeAg) negative chronic hepatitis B has been recently reported in many countries. The aim of this study was to analyze the frequency and the characteristics of HBeAg-negative as compared with HBeAg-positive chronic hepatitis B in France.

Methods

Eight hundred and sixty-five patients with histologically proven chronic hepatitis B seen in 26 University centers were included. The proportion with HBeAg-negative chronic hepatitis B was 72% and higher in patients born in Africa, Middle East, Eastern, and Southern Europe than in those of French or Asian origin. HBeAg-negative patients were significantly older (p < 0.001) and had lower ALT levels and HBV DNA serum levels (p < 0.01) than HBeAg-positive patients. An unknown source of infection was more prevalent in HBeAg-negative patients (p < 0.05). Fibrosis score (p < 0.05) and proportion of cirrhosis (p < 0.01) were significantly higher in HBeAg-negative patients. Age older than 50 years, male gender and viral load lower than 5 logs10 copies/mL were independently associated with cirrhosis.

Results

HBeAg-negative chronic hepatitis B is predominant in France. This observation is important for an optimized clinical management and future therapeutic trials in chronic hepatitis B.

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.

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