Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
Department of Gastroenterology, Ren-Ai Branch, Taipei City Hospital, Taipei, Taiwan.
J Med Virol. 2023 Oct;95(10):e29138. doi: 10.1002/jmv.29138.
The full spectrum of risks for the life course of inactive hepatitis B virus (HBV) carriers remains unclear. In this study, 995 untreated HBV carriers (median age: 42.8 years; median follow-up: 30.2 years) were included. Their data were sourced from a population-based cohort study of male civil servants recruited in 1989-1992. Outcomes were identified by active follow-up examinations and linkage with national health insurance research database. At baseline, 483 subjects were inactive carriers, 385 with indeterminate phase, and 127 with other phases. The joint lifetime risk for incident cirrhosis, decompensation, hepatocellular carcinoma, and liver-related deaths was lower for inactive carriers compared to subjects in other phases (p < 0.0001). There was a trend of increase in incidence among inactive carriers; the 5-, 10-, and 20-year cumulative incidences were 1.86%, 6.03%, and 10.07%, respectively. Of the inactive carriers, 37.7% cleared HBsAg and 36.6% had biochemical relapse during the study. Biochemical relapse, obesity, and advanced age were predictors for disease progression in inactive carriers. Virological relapse was the predominant cause of biochemical relapse. Higher HBV-DNA levels (≥1000 copies/mL or 200 IU/mL) and HBV genotype B (vs. C) were associated with higher virological relapse rate. After 30 years, we found that one-time measure of inactive carrier state continued to have the lowest risk compared with other infection phases. Despite a more favorable prognosis, inactive carriers had a non-negligible risk. Our findings of lifetime risk may provide important clues for the management of such patients and consideration of therapeutic strategies aiming to achieve functional cure.
慢性乙型肝炎病毒（HBV）携带者的终身风险全貌仍不清楚。本研究纳入了 995 名未经治疗的 HBV 携带者（中位年龄：42.8 岁；中位随访时间：30.2 年）。这些数据来源于一项基于人群的队列研究，研究对象为 1989-1992 年招募的男性公务员。通过主动随访检查和与国家健康保险研究数据库的链接来确定结局。基线时，483 例为非活动携带者，385 例为不确定期，127 例为其他期。与其他期相比，非活动携带者发生肝硬化、失代偿、肝细胞癌和与肝脏相关死亡的联合终身风险较低（p<0.0001）。非活动携带者的发病率呈上升趋势；5、10 和 20 年的累积发病率分别为 1.86%、6.03%和 10.07%。在非活动携带者中，37.7%清除了 HBsAg，36.6%在研究期间出现了生化复发。生化复发、肥胖和年龄增长是非活动携带者疾病进展的预测因素。病毒学复发是生化复发的主要原因。较高的 HBV-DNA 水平（≥1000 拷贝/ml 或 200 IU/ml）和 HBV 基因型 B（与 C 相比）与较高的病毒学复发率相关。30 年后，我们发现与其他感染期相比，单次测量的非活动携带者状态的风险仍然最低。尽管预后较好，但非活动携带者仍存在不可忽视的风险。我们对终身风险的研究结果可能为这些患者的管理提供重要线索，并考虑旨在实现功能性治愈的治疗策略。
