Cirrhosis in Young Chronic Hepatitis B Patients with Low Viral Load and HBeAg-Negative Status: Result of Extended Screening for Co-Morbidities
K Sivarajah, OA Adeyi. University of Toronto/UHN, Toronto, ON, Canada
Background: The natural history of hepatitis B contracted perinatally typically follows a period of immune-tolerant phase, followed usually in late teen by immune clearance phase, which if progressive leads to cirrhosis. Risk factors for progression to cirrhosis include high viral load, age, severity and frequency of inflammation in the immune clearance phase, positive e-antigen status, HCV co-infection, and fatty liver among others, and these are usually screened for at most centers. In this study we aimed at identifying other factors responsible for progression in patients with none of these usually screened risk factors.
Design: The records of UHN patients younger than 40 years biopsied for chronic viral hepatitis B over a period of 7 years (2001 -2007) were reviewed. Biopsies were reviewed and patients with stages 3 and 4 fibrosis on the modified Metavir scale were included. Their e-antigen status and viral loads were documented. Patients with known hepatitis C co-infection, previous antiviral therapy, and /or steatosis/steatohepatitis on biopsy were excluded. Additional clinical, serologic and biochemical data were sought with a view to determining other contributors to cirrhosis other than chronic hepatitis B.
Results: Twenty-six untreated HBV patients <40 years old with advanced fibrosis were identified over the study period. 10 patients aged 20 to 34 years were e-antigen-negative, of whom 4 (40%) tested positive for hepatitis D (HDV); 3 (30%) by urine and quantitative tissue copper measurement indicate possible co-exiting Wilson's disease (WD), and the remaining 3 (30%) patients have no other apparent explanation for their cirrhosis. 16 patients were e-Ag+ of whom 2 (12.5%) have possible WD. The e-Ag+ group have significantly higher viral load that the negative group (mean 5.5 logs versus less than 1 log).
Conclusions: Young chronic HBV patients with cirrhosis, especially those with low viral load and negative e-Ag, should be considered for extended screening for Wilson's disease and HDV; in this study 7 of 10 patients in this category tested positive for either HDV co-infection or WD.
Category: Liver & Pancreas
Tuesday, March 10, 2009 9:30 AM
Poster Session III # 151, Tuesday Morning