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Comparable mortality between Asian chronic hepatitis B patients under long-term antiviral therapy vs. matched control: a population-based study.

OBJECTIVES
Antiviral therapy (AVT) substantially improved the prognosis for patients with chronic hepatitis B (CHB). Head-to-head comparisons of prognosis between treated patients with CHB and the general population are scarce. We directly compared the prognosis between Asian patients with CHB receiving AVT and the general population.


METHODS
From the South Korean National Health Insurance Service database, patients with CHB receiving AVT≥3 years, aged 40-64 years, who underwent health examinations between 2011 and 2012 (CHB-AVT group) were recruited. As a control, propensity-score-matched general population was chosen among patients without CHB. The primary outcome was all-cause mortality; secondary outcomes were cardiovascular disease (CVD), hepatocellular carcinoma (HCC), and all types of non-HCC malignancies.


RESULTS
During follow-up (median 7.2 years), 26,467 and 75,469 individuals in the CHB-AVT group and matched general population were analyzed. The 5- and 7-year cumulative all-cause mortality rates were 0.40% and 1.0% for CHB-AVT group vs. 0.50% and 1.0% for matched general population (adjusted hazard ratio [aHR] 0.96, 95% confidence interval [CI] 0.83-1.10; p=0.51). The AVT-CHB group had a lower risk of CVD than the matched general population (aHR 0.70, 95% CI: 0.62-0.79; p <0.001). Although the CHB-AVT group was more likely to develop HCC than the matched general population (aHR 13.16, 95% CI: 10.90-15.89; p <0.001), the non-HCC malignancies risk in the CHB-AVT group were comparable to the matched general population (aHR 1.05, 95% CI 0.98-1.13; p =0.137).


CONCLUSIONS
CHB-AVT group had a similar risk of all-cause mortality and non-HCC malignancies and a lower risk of CVD than the matched general population.