Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece;. Electronic address: firstname.lastname@example.org.
Department of Hygiene, Epidemiology & Medical Statistics, Medical School of National and Kapodistrian University of Athens, Athens, Greece.
Department of Internal Medicine, Thessalia University Medical School, Larissa, Greece.
Department of Gastroenterology, University of Ankara Medical School, Ankara, Turkey.
Section of Hepatology, Clinic for Gastroenterology and Rheumatology, University Clinic Leipzig, Germany.
Hospital General Universitario Valle Hebron and Ciberehd, Barcelona, Spain.
4th Department of Internal Medicine, Αristotle University of Thessaloniki Medical School, Thessaloniki, Greece.
Hospital U Puerta de Hierro, IDIPHIM CIBERehd, Madrid, Spain.
Department of Gastroenterology & Hepatology, Erasmus MC, University Medical Center, Rotterdam, Netherlands.
2nd Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Athens, Greece.
CRC "AM e A Migliavacca" Center for Liver Disease, Division of Gastrotnerology and Hepatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italy.
Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece.
Humanitas Clinical and Research Centre, Rozzano, Italy.
Department of Gastroenterology & Hepatology, Erasmus MC, University Medical Center, Rotterdam, Netherlands; Liver Clinic, Toronto Western & General Hospital, University Health Network, Toronto, ON, Canada.
The effects of long-term antiviral therapy on survival have not been adequately assessed in chronic hepatitis B (CHB). In this 10-center, ongoing cohort study, we evaluated the probability of survival and factors affecting survival in Caucasian CHB patients treated with long-term entecavir/tenofovir therapy.
We included 1951 adult Caucasians with CHB with or without compensated cirrhosis and no hepatocellular carcinoma (HCC) at baseline who received entecavir/tenofovir for ≥12 months (median: 6 years). Kaplan-Meier estimates of cumulative survival over time were obtained. Standardized mortality ratios (SMR) were calculated by comparing death rates with the Human Mortality Databases.
The 1-, 5- and 8-year cumulative probabilities were 99.7%, 95.9% and 94.1% for overall survival, 99.9%, 98.3% and 97.4% for liver related survival and 99.9%, 97.8% and 95.8% for transplantation free liver related survival. Overall mortality was independently associated with older age and HCC development, liver related mortality with HCC development only and transplantation free liver related mortality with HCC development and lower platelets at baseline. Baseline cirrhosis was not independently associated with any type of mortality. Compared to general population, mortality was not significantly different in all CHB patients (SMR: 0.82), while it was lower in patients without HCC regardless of baseline cirrhosis (SMR: 0.58) and higher in patients who developed HCC (SMR: 3.09).
Caucasian patients with CHB and compensated liver disease treated with long-term entecavir/tenofovir therapy have excellent overall and liver related 8-year survival, which is similar to that of the general population. HCC is the main factor affecting their overall mortality and the only factor affecting their liver related mortality.
Caucasian chronic hepatitis B patients with or without compensated cirrhosis treated with long-term entecavir or tenofovir therapy have an excellent overall 8-year survival which is similar to that of the general population. Hepatocellular carcinoma is the main factor affecting their overall mortality and the only factor affecting liver related mortality in this setting.