Naïve hepatitis B e antigen-negative chronic hepatitis B patients are at risk of carotid atherosclerosis: A prospective study.

BACKGROUND

There is an increased risk of atherosclerosis in patients with chronic hepatitis C or human immunodeficiency virus, but there is scarce data on hepatitis B virus infection. The hypothesis of this study is that hepatitis B virus infection increases the risk of carotid plaques and subclinical atherosclerosis in naïve hepatitis B e antigen (HBeAg) negative subjects.

AIM

To assess the rate of carotid plaques and subclinical atherosclerosis in naïve HBeAg negative subjects in comparison with a cohort of healthy controls.

METHODS

Prospective case-control collaborative study conducted in two tertiary hospitals. Four hundred and two subjects prospectively recruited at the outpatient clinic were included from May 2016 to April 2017: 201 naïve HBeAg-negative hepatitis B virus-infected [49 chronic hepatitis B (CHB) and 152 inactive carriers(ICs)] and 201 healthy controls. Anthropomorphic and metabolic measures, liver stiffness and carotid Doppler ultrasound were performed. Subclinical atherosclerosis was established on an intima-media thickness increase of ≥1.2 mm and/or the presence of carotid plaques. Normally distributed quantitative variables were compared with the Student test and those with a non-normal distribution with the Mann-Whitney test. Categorical variables were compared between groups using the or Fisher exact test.

RESULTS

Carotid plaques were found more often in CHB (32.7%) than ICs (17.1%) or controls (18.4%) ( = 0.048). Subclinical atherosclerosis was also increased in CHB (40.8%) ICs (19.1%) or controls (19.4%) ( = 0.003). No differences in the risk of atherosclerosis were observed between controls and ICs. The factors independently associated with the presence of carotid plaques were age [odds ratio(OR) 1.43, < 0.001] and CHB (OR 1.18, = 0.004) and for subclinical atherosclerosis, age (OR 1.45, < 0.001), CHB (OR 1.23, < 0.001) and diabetes (OR 1.13, = 0.028). In the subset of young subjects (< 50 years), carotid plaques (12.5% 1.1%, = 0.027) and subclinical atherosclerosis (12.5% 2.2%, = 0.058) were more frequent among CHB than ICs.

CONCLUSION

Untreated HBeAg-negative CHB is an independent risk factor for carotid plaques and subclinical atherosclerosis, while ICs present a similar risk to controls.