Background & Aims

Most patients in the immunotolerant (IT) phase of chronic hepatitis B (CHB) transition to the immune active (IA-hepatitis B surface antigen [HBeAg]+) phase by early adulthood. We examined characteristics of adults in the IT vs IA-HBeAg+ phase and rate of transition from IT to other phases of CHB, with a focus on those ≥40 years.

Methods

Demographic, clinical, and virologic characteristics of participants in the Hepatitis B Research Network adult cohort study with IT CHB (alanine aminotransferase ≤1.5 × upper limit of normal, hepatitis B virus DNA >10⁷ IU/mL) were compared by age category, and to those with IA-HBeAg+ CHB in cross-sectional analysis. This study received institutional review board approval at all participating centers.

Results

Of 107 adult IT participants, 52 (48%) were <30, 33 (31%) were 30 to 39, and 22 (21%) were ≥40 years old (maximum, 71 years). Among IT groups, the proportion born in Asia and duration of CHB were greater in older IT groups, but virologic and liver disease characteristics were similar. Compared with IA-HBeAg+ participants (n = 192), IT participants were younger, fewer were men, more were Asian, and platelets, qHBsAg, and qHBeAg levels were higher. Similar differences were observed when comparisons were made with the ≥40 years IT group. Among IT participants, 60 (56%) transitioned during 206 person-years of follow-up. The phase transition rate per 100 person-years was highest in the <30 years group (33.0 [95% confidence interval [CI], 23.4-46.7]) vs the 30 to 39 years group (24.8 [95% CI, 15.6-39.4]) and ≥40 group (27.4 [95% CI, 14.8-50.9]), but 95% CIs overlapped.

Conclusions

In a large North American population, over 50% of adults in the IT phase of CHB were ≥30 years and 20% were ≥40 years old, but older IT patients had similar characteristics and rates of transition as younger IT patients.

中文翻译：

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老年免疫耐受慢性乙型肝炎病毒感染患者的特征

 背景与目标

大多数处于慢性乙型肝炎 (CHB) 免疫耐受 (IT) 阶段的患者会在成年早期过渡到免疫活跃（IA-乙型肝炎表面抗原 [HBeAg]+）阶段。我们研究了成人在 IT 阶段与 IA-HBeAg+ 阶段的特征以及从 IT 阶段到 CHB 其他阶段的转变率，重点关注 ≥ 40 岁的人群。

 方法

按年龄类别对乙型肝炎研究网络成人队列研究的 IT CHB 参与者（丙氨酸转氨酶 ≤1.5 × 正常上限，乙型肝炎病毒 DNA >10 ⁷ IU/mL）的人口统计学、临床和病毒学特征进行比较，并横断面分析中 IA-HBeAg+ CHB 患者的情况。这项研究得到了所有参与中心机构审查委员会的批准。

 结果

在 107 名成人 IT 参与者中，52 名 (48%) 为 <30，33 名 (31%) 为 30 至 39 岁，22 名 (21%) ≥40 岁（最大 71 岁）。在 IT 群体中，年龄较大的 IT 群体中出生于亚洲的比例和慢性乙型肝炎病程更长，但病毒学和肝病特征相似。与 IA-HBeAg+ 参与者 (n = 192) 相比，IT 参与者更年轻，男性较少，亚洲人较多，血小板、qHBsAg 和 qHBeAg 水平较高。当与 ≥40 岁 IT 组进行比较时，也观察到类似的差异。在 IT 参与者中，60 人 (56%) 在 206 人年的随访期间发生了转变。每 100 人年的相变率在 <30 岁组中最高（33.0 [95% 置信区间 [CI], 23.4-46.7]），而 30 至 39 岁组（24.8 [95% CI, 15.6-39.4]） ]）和 ≥40 组（27.4 [95% CI，14.8-50.9]），但 95% CI 重叠。

 结论

在大量北美人群中，超过 50% 的慢性乙型肝炎 IT 期成年人年龄≥30 岁，20% ≥40 岁，但老年 IT 患者与年轻 IT 患者具有相似的特征和转变率。