Characteristics and outcomes of acute hepatitis B in Argentina: results from the acute hepatitis B global study

MARCIANO S; MENDIZABAL M; CALZETTA P; GADANO A; TRINKS J; ARRIGO D; GIUNTA D; TRINKS J; ARRIGO D; FLICHMAN D; GIUNTA D; LIVELLARA B; FLICHMAN D; VUJACICH C; MARCIANO S; LIVELLARA B; VUJACICH C; MENDIZABAL M; CALZETTA P; GADANO A

Punta Cana

Congreso; XXV Congreso de la Asociación Latinoamericana para el Estudio del Hígado; 2018

Asociación Latinoamericana para el Estudio de las Enfermedades del Hígado (ALEH)

Background. Acute hepatitis B virus (HBV) infection continues to be an important health problem worldwide. Studies reporting outcomes in patients with acute hepatitis B were performed more than 20 years ago. Aim. To describe the characteristics of acute hepatitis B and to estimate the proportion of patients who develop acute liver failure (ALF) or evolution to chronic hepatitis B (CHB). Material and methods. From August 2015 to September 2017 patients aged > 17 years with acute hepatitis B were prospectively included. Acute hepatitis B was considered in symptomatic patients with positive anti-HBc IgM and ALT > 250 IU/L. Patients who underwent immunosuppressive therapies during the 24 week-period prior to enrolment or who were unwilling to consent were excluded. Patients were followed for 6 months and divided into three groups according to the evolution of the acute infection: patients who resolved the infection (HBsAg clearance during follow up), patients who develop ALF (prothrombin time < 50% and any grade of hepatic encephalopathy) and patients who evolved to CHB (HBsAg persistence at 6 months of follow up). Results. 200 patients were included. Median age was 44 (35 - 56) years and 163 (81%) were male. Sexual transmission was declared in 169 (84%) patients. Median ALT was 2,528 (IQR 1,543 - 3,715) IU/L and median total bilirubin 10.7 (IQR 6.1 - 19) mg/dL. HBV genotype was available in 145 patients: F: 111 (77%), A: 29 (20%) and D: 5 (3%). At diagnosis, 9 (4.6%) patients were HIV co-infected and 171 (89%) were HBeAg-positive. No cases of HCV co-infection were observed. A total of 15 patients developed ALF (7.5%, 95% CI: 4.5% - 12.1%), of whom 9 (60%) died, 4 (27%) underwent liver transplantation and 2 (13%) survived with supportive care. Evolution to CHB was observed in 23 patients (11.5%, 95% CI: 7.7%-17.0%). Conclusions. Almost 20% of adults with acute hepatitis B present unfavorable outcomes (ALF or evolution to CHB) which is higher than what was historically reported.