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Clinical management of chronic hepatitis B infection: results from a registry at a German tertiary referral center

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Abstract

Purpose

We studied a cohort of adult patients with chronic hepatitis B (CHB) infection, followed at a tertiary referral liver center in Germany over 12.5 years to analyze the clinical features and impact of management on disease progression and survival of CHB patients in general and of those with CHB and HCC in particular.

Methods

We retrospectively evaluated the medical records of 242 adult (age ≥ 18 years) patients. CHB was defined as positive hepatitis B surface antigen (HBsAg) and/or HBV-DNA levels >10 IU/mL for at least 6 months. Patient demographics, HBV markers, antiviral treatment, laboratory parameters, liver imaging and histology were recorded for each visit. HCC patients were divided into two groups and separately analyzed (group 1: n = 24, HCC at first visit and group 2: n = 11, HCC during surveillance).

Results

The mean age was 44 years in CHB patients without HCC (63 % male) and about 59 years in patients with HCC (77 % male). Antiviral therapy was given to 59 % of patients without HCC compared to only 25 % in group 1 and 18 % in group 2 with comparable median HBV DNA levels of approximately 36,000 IU/mL. There was no statistically significant difference concerning the HCC stages (Milan, UCSF, BCLC) at first diagnosis. Five-year survival was 19 % in group 1 vs. 64 % in group 2 (p = 0.019), with LTx performed in 12 vs. 45 %, respectively.

Conclusion

Surveillance of CHB patients did not result in early stage detection of HCC but in a higher likelihood to receive potentially curative treatments.

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Acknowledgments

Gerd Fätkenheuer and I met for the first time in 1987 when he started his academic career at the Medical Clinic II (Director W. Kaufmann) of the University Hospital of Cologne. It was during the early days of the HIV epidemic when he together with M. Schrappe and B. Salzberger was taking care for HIV-infected in- and outpatients. Since I was predominantly interested in cardiology at that time we published in 1990/1991 together with his colleagues data on echocardiographic abnormalities in this patient group. After the whole “HIV-study-group” was transferred to the Medical Clinic I (Director V. Diehl) we never lost sight of each other even so we differed in our research agenda. In 2008 we started a series of lectures which was quite an experience since we tried to explain to our students how to prevent errors in medicine. During the last 2 years I now have the great pleasure to work with him within the Cologne-Lighthouse Partnership giving lectures and teaching courses for medical officers at a HIV treatment center in Lilongwe, Malawi. Prof. Dr. med. Hans-Michael Steffen, Deputy Director of the Clinic for Gastroenterology and Hepatology at the University Hospital of Cologne.

Conflict of interest

There is no commercial affiliation or consultancy of any author that could be construed as a conflict of interest with respect to the submitted data. There was also no funding of this study.

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Authors and Affiliations

  1. Clinic for Gastroenterology and Hepatology, University Hospital of Cologne, 50924, Cologne, Germany

    M. Demir, J. Nigemeier, F. Kütting, A. Bowe, C. Schramm, V. Hoffmann, D. Waldschmidt, T. Goeser & H-M. Steffen

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  1. M. Demir
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  2. J. Nigemeier
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  3. F. Kütting
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  4. A. Bowe
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  6. V. Hoffmann
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  7. D. Waldschmidt
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  8. T. Goeser
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  9. H-M. Steffen
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Correspondence to M. Demir.

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Demir, M., Nigemeier, J., Kütting, F. et al. Clinical management of chronic hepatitis B infection: results from a registry at a German tertiary referral center. Infection 43, 153–162 (2015). https://doi.org/10.1007/s15010-015-0751-4

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  • DOI: https://doi.org/10.1007/s15010-015-0751-4

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