Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Apr 14, 2012; 18(14): 1616-1621
Published online Apr 14, 2012. doi: 10.3748/wjg.v18.i14.1616
Impact of comorbidities on the severity of chronic hepatitis B at presentation
Evangelista Sagnelli, Tommaso Stroffolini, Alfonso Mele, Michele Imparato, Caterina Sagnelli, Nicola Coppola, Piero Luigi Almasio
Evangelista Sagnelli, Michele Imparato, Nicola Coppola, Department of Public Medicine, Section of Infectious Diseases, Second University of Naples, 80132 Naples, Italy
Tommaso Stroffolini, Department of Infectious and Tropical Diseases, Policlinico Umberto I, 00161 Rome, Italy
Alfonso Mele, Laboratory of Epidemiology, Clinical Epidemiology Unit, Istituto Superiore di Sanità, 00161 Rome, Italy
Caterina Sagnelli, Department of Clinical and Experimental Medicine and Surgery "F. Magrassi e A. Lanzara", Second University of Naples, 80132 Naples, Italy
Piero Luigi Almasio, Gastroenterology Unit, University of Palermo, 90127 Palermo, Italy
Author contributions: Sagnelli E, Mele A, Stroffolini T and Almasio PL contributed equally in designing the research; Imparato M, Sagnelli C and Coppola N contributed equally in collecting the data; Almasio PL analysed the data; Sagnelli E wrote the manuscript; all the other authors collected the data in the Peripheral Centres.
Supported by A grant from the Progetto di Ricerca di Interesse Nazionale 2000 and in part with a grant from the Viral Hepatitis Project; Istituto Superiore di Sanità, D. leg.vo 30/12/1992 n. 502; this study was performed with the support of Glaxo Smith-Kline
Correspondence to: Evangelista Sagnelli, Full Professor of Infectious Diseases, Department of Public Medicine, Section of Infectious Diseases, Second University of Naples, Via Luciano Armanni n.5, 80132 Naples, Italy. evangelista.sagnelli@unina2.it
Telephone: +39-8-15666271 Fax: +39-8-23232296
Received: March 7, 2011
Revised: August 4, 2011
Accepted: February 26, 2012
Published online: April 14, 2012
Abstract

AIM: To evaluate the clinical relevance of each cofactor on clinical presentation of chronic hepatitis B.

METHODS: Out of 1366 hepatitis B surface antigen (HBsAg) positive subjects consecutively observed in 79 Italian hospitals, 53 (4.3%) showed as the only cofactor hepatitis D virus (HDV) infection [hepatitis B virus (HBV)/HDV group], 130 (9.5%) hepatitis C virus (HCV) (group HBV/HCV), 6 (0.4%) human immunodeficiency virus (HIV) (group HBV/HIV), 138 (10.2%) alcohol abuse (group HBV/alcohol); 109 (8.0%) subjects had at least two cofactors and 924 were in the cofactor-free (CF) group.

RESULTS: Compared with patients in group CF those in group HBV/alcohol were older and more frequently had cirrhosis (P < 0.001), those in group HBV/HDV were younger (P < 0.001), more frequently resided in the south of the country and had cirrhosis (P <0.001), those in group HBV/HCV were older (P < 0.001) and more frequently had cirrhosis (P < 0.001). These cofactors were all independent predictors of liver cirrhosis in HBsAg positive patients. Multivariate analysis showed that an older age [odds ratio (OR) 1.06, 95% CI: 1.05-1.08], alcohol abuse with more than 8 drinks daily (OR 2.89, 95% CI: 1.81-4.62) and anti-HDV positivity (OR 3.48, 95% CI: 2.16-5.58) are all independently associated with liver cirrhosis. This association was found also for anti-HCV positivity in univariate analysis, but it was no longer associated (OR 1.23, 95% CI: 0.84-1.80) at multivariate analysis.

CONCLUSION: Older age, HDV infection and alcohol abuse are the major determinants of severe liver disease in chronic HBV infection, while HCV replication plays a lesser role in the severity of hepatic damage.

Keywords: Chronic hepatitis B; Hepatitis B virus/hepatitis D virus dual infection; Hepatitis B virus/hepatitis C virus dual infection; Alcohol abuse