engleski

The prognosis of chronic hepatitis B in patients on no antiviral tehrapy

A group of 52 patients with hystologically verified chronic hepatitis B infection were followed up for 5 years. All patients were HbsAg positive, non-alcoholic, and non-drug addicts. The aim of the study was to establish the natural hystory of chronic HBV hepatitis in our patients. The markers of viral replication, i.e. the levels of HBV DNA, HBV DNA polymerase, and IgM anti-HBc antibodies, were prospectivelly determinated in the patient sera, in order to define the criteria and predictive factors for responding to antiviral interferon therapy. Study results showed HBV to cause serious hepatic diseases, including cirrhosis, chronic active hepatitis and chronic persistent hepatitis in 46, 15 percent, 27 percent and 19 percent of cases, respectively. All our patients with liver cirrhosis were clinically in Child-Pugh A stage throughout the five-year period, despite progressive liver disease and no antiviral therapy. At the end of the study, a mortality rate of 5, 7 percent was recorded. Also, mutant HBV was for the first time demonstrated to cause a very severe hepatic disease in 26, 08 percent of cases. It was found that 44, 23 percent of chronic HBV hepatitis patients were positive for HBV DNA, 60 percent of them with cirrhosis, and 21, 7 parcent with chronic active hepatitis. All these patients met the criteria for antiviral (interferon) therapy, but those with cirrhosis represented a risk group for this therapy. The serologic markers of HBV DNA and HBV DNA polymerase weer found to be the most sensitive tests to determine the criteria and predictive factors for the response to antiviral therapy. The monoclonal antibody-based radioimmunoassy for HbsAg detection in serum from HBV hepatitis patients had the same value as the polyclonal radioimmunoassay in daly clinical pratice. IgM antibodies were positive in 42, 30 percent of patients with chronic HBV hepatitis who also had a two-fold increase in their biochemical parameters of AST and ALT compared to normal. These antibodies were found useful to assess the hepatic disease activity . The five-year follov-up of the patients with chronic HBV diseases confirmed the recently emphasized need of search for new and more efficient drugs for the treatment of chronic HBV hepatitis.

chronic hepatitis B; viral replication; antiviral therapy; disease prognosis

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