Long-term prognosis of patients with hepatitis B infection: causes of death and utility of nucleos(t)ide analogue therapy.

Background: Long-term nucleos(t)ide analogue (NA) therapy for chronic hepatitis B (CHB) patients has been reported to reduce the risk of hepatocellular carcinoma (HCC) development. However, survival rates and causes of death in CHB patients either treated or not treated with NA therapy are unclear. Therefore, we investigated the prognosis of CHB in both of these groups.

Methods: A total of 919 CHB patients who were treated (n = 189) or not treated (n = 730) with NA therapy were enrolled; of these, 135 were selected from each group by propensity score matching. Survival, mortality from both HCC and non-liver related diseases, and causes of death were analyzed.

Results: In all patients (n = 919), cumulative survival and mortality from both HCC and non-liver related diseases did not differ significantly according to NA therapy status. Of 66 patients who died during the follow-up period, 59.1% died due to liver-related diseases (including HCC); of the remainder, 48.1% died of non-liver related malignancies. In patients selected by propensity score matching (n = 270), cumulative survival and mortality from HCC were significantly improved in those who received NA therapy compared with those who did not (p = 0.015 and 0.018, respectively). Cox proportional hazards models indicated that NA therapy was independently associated with survival of CHB patients (hazard ratio, 0.286; 95% confidence interval, 0.122-0.668; p = 0.004).

Conclusions: Approximately 40% of CHB patients died of non-liver-related diseases. Additionally, in patients who required anti-viral therapy for CHB, NA therapy improved survival and mortality from HCC.