High
HBV Viral Load and Being HBeAg Positive Are Associated with
Decreased Life Expectancy for People with Hepatitis B
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| SUMMARY:
Despite the availability of an effective vaccine,
hepatitis B virus
(HBV) infection remains a significant cause
of morbidity and mortality in the U.S. Individuals
with chronic hepatitis B have a shorter life expectancy
than uninfected people, according to a mathematical
model presented last week at the 60th Annual Meeting
of the American Association for the Study of Liver
Diseases (AASLD) in
Boston. High HBV viral load and being hepatitis
B "e" antigen (HBeAg) positive were
associated with shorter survival. |
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By
Liz Highleyman
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Hepatitis
B Virus
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Researchers
at the University of Cincinnati constructed a Markov state
transition model to simulate the natural history of hepatitis
B progression over the lifetime of a hypothetical cohort,
and to estimate quality adjusted life expectancies in various
groups of people with current or past HBV infection.
The
target population was defined as U.S. adults age 35 or older,
classified as being not HBV infected, immune to HBV (e.g.,
due to vaccination), or chronically infected (defined as
hepatitis B surface antigen [HBsAg] positive). The chronic
infection group was further stratified according to HBeAg
status, HBV DNA viral load, and liver function tests (e.g.,
ALT liver enzyme levels).
The
investigators used published studies in the medical literature
to determine ranges of seroconversion, liver
fibrosis progression, development of hepatocellular
carcinoma, and end-stage
liver disease. Life expectancies for each cohort were
determined by running the Markov simulation until only 1
out of 10,000 members remained alive.
Results
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Individuals without active HBV infection or with HBV
immunity had higher life expectancies (both 44.6 years)
than those with chronic HBV infection (37.7 years).
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Among
HBeAg positive people with normal liver function tests,
considered to be immune tolerant, overall life expectancy
was 30.7 years, but this varied according to HBV DNA
level: |
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High
viral load: 27.5 years; |
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Low
viral load: 34.5 years. |
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Among
HBeAg negative people with normal liver function tests,
considered to be chronic asymptomatic, life expectancy
was 36.8 years: |
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High
viral load: 33.3 years; |
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Low
viral load: 34.9 years. |
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"Life
expectancy differences were observed across chronic subgroups,
with HBeAg positive having shorter projected lifespans,"
the researchers determined. "High viral load is the
most important factor associated with decreased life expectancy.
Sensitivity analyses demonstrate that spontaneous seroconversion
rates significantly affect outcomes."
"The
model demonstrates that all chronic HBV subgroups have decreased
survival, but there is considerable variability in overall
life expectancy which is highly sensitive to HBV viral load,"
they concluded.
Division
of Digestive Disease, University of Cincinnati, Internal
Medicine, Cincinnati, OH; Division of General Internal Medicine
and Center for Clinical Effectiveness, University of Cincinnati,
Internal Medicine, Cincinnati, OH.
11/10/09
Reference
TE
Kaiser, KE Sherman, and MH Eckman. Simulation Modeling of
the Natural History of Hepatitis B Progression in a United
States Adult Population - Determining Life Expectancies.
60th Annual Meeting of the American Association for the
Study of Liver Diseases (AASLD 2009). Boston. October 30-November
1, 2009. Abstract 420.
