Natural history of hepatitis B surface antigen-positive cirrhosis in Taiwan: A clinicopathological study

To clarify the natural history of hepatitis B virus (HBV)-associated liver cirrhosis, the clinical, laboratory and histological features of 174 untreated hepatitis B surface antigen (HBsAg)-positive cirrhotics were analysed, with a mean follow-up period of 34 months (range 8–135 months) after liver biopsy. Male patients were predominant (86.8%) and the mean age of the whole group was 45 years, s.d. = 12 (range 15–82 years). Serum HBeAg and HBV-DNA positivity were 38.9% and 31.8%, respectively. The calculated annual rate of spontaneous HBeAg seroconversion was 6.4% which was significantly lower than that (12%) of patients with HBeAg-positive chronic active hepatitis (CAH). Superinfection by δ-agent was rare, and anti-δ antibody was detected in only 1.7% of them. The occurrence rate of hepatocellular carcinoma in the whole group was 5.7%/year which was not higher than that of HBsAg-negative cirrhotics (6.2%/year). Serial liver biopsy showed that in the late evolution of cirrhosis, hepatitic activity tended to decline. Active cirrhosis may represent the intermediate stage between CAH and inactive liver cirrhosis. The 5-year survival probability rate of the patients belonging to Child's functional classes A, B and C was 83.4% (s.d. = 5.7), 79.2% (s.d. = 9.4) and 30.9% (s.d. = 14.3), respectively. Most patients were in a well-compensated state on entry into the study and remained stable for several years after diagnosis. Major causes of death include massive variceal bleeding, hepatic failure and/or hepatorenal syndrome, infection and hepatocellular carcinoma.