Vagaries of the Host Response to Chronic Hepatitis B Virus Infection: What is the Ultimate Outcome of So-called “Asymptomatic HBV Carriers” Observed Over Several Decades?

Nicholas Noverati,Hie-Won Hann,Daniel Garrido,Dina Halegoua-Demarzio

doi:10.29245/2578-3009/2021/4.1224

Abstract

Introduction: Chronic hepatitis B virus (HBV) infection is prevalent worldwide and up to 40% is known to progress to serious complications including cirrhosis and hepatocellular carcinoma (HCC). The outcome of the remaining infected individuals is not well documented. Our case series describes a longer cohort of chronic HBV infections that have remained asymptomatic with no progression of liver disease. Case Series: Thirty-three patients (ages 31-84) with chronic HBV infection were identified. All patients had no significant elevations in transaminase levels and were followed over 32 years, collectively. 18/33 had a fluctuating greater magnitude of HBV viral load with no elevations in tumor marker or significant radiographic changes to their liver. Discussion/Conclusion: Chronic HBV infection can lead to serious complications over time, the mechanism of which are not well understood. The variation in patients that do and do not develop these complications stresses the importance of the individual response to the virus and may highlight host immune response differences.

Highlights

Since the discovery of hepatitis B virus (HBV) by Blumberg et al in 1965, his first vaccine in 1982, and subsequently highly effective antiviral drugs, there has been a significant decrease in the number of infected people globally and especially in younger generations.[1]
It is critical to study chronic HBV infection as it is still responsible for nearly 50% of hepatocellular carcinoma (HCC) worldwide and 600,000 to one million die annually from HBVrelated liver disease.[2,3,4,5,6]
Fifteen to 40% of patients with chronic HBV are expected to progress to cirrhosis and HCC.[7,8]

Summary

Introduction

Since the discovery of hepatitis B virus (HBV) by Blumberg et al in 1965, his first vaccine in 1982, and subsequently highly effective antiviral drugs, there has been a significant decrease in the number of infected people globally and especially in younger generations.[1]. Some reports have described two forms of HBsAg positive, HBeAg negative subjects with normal ALT levels: those who are true healthy carriers and others with chronic HBV infection with transient virological and biochemical remission.[9,24]. Our purpose of this 33-case series is to display and examine longitudinally collected data from patients with asymptomatic, inactive chronic HBV infections that have not undergone treatment or developed HCC or cirrhosis. 26.35 years, though the years with known HBsAg status for paternal transmission and unknown groups are a rough estimate of the length of their hepatitis B infection For those infected at birth, the infected duration is their age

Discussion

Findings

Strengths and Limitations

Summary and Conclusions