HBsAg+ and HBsAg- Chronic Active Hepatitis, Liver Cirrhosis and Hepatocellular Carcinoma in Korea:Prevalence and Difference in Age Distribution

Abstract

Korea is one of the endemic areas of hepatitis B virus infection. In clinical practice, we have suspected that HBsAg+ patients with chronic liver disease (CLD) are younger than HBsAg - patient. In order to determine the prevalence of HBV infection more clearly in patients with CLD and to investigate the difference in age-specific distribution between HBsAg+ and HBsAg- patients, we consecutively enrolled 3185 patients with chronic active hepatitis (CAl-I), 1919 patients with liver cirrhosis (LC) and 628 patients with hepatocellular carcinoma (HCC) who were diagnosed in the liver unit at Seoul National University Hospital from 1973 to 1991. HBsAg was positive in 61.4%, 67.8% and 68.9% of patients with CAH, LC and HCC, respectively. In comparison, anti-HBs was positive only in 16.4%, 14.4% and 11.6% of patients with CAH, LC and HCC, respectively. Among HBsAg- patients, patients with isolated antibody to HBc were most common; 15.6%, 13.9% and 15.4% in CAH, LC and HCC, respectively. Almost all of the patients with CAH, LC and HCC (93.4%, 96.1% and 95.9%, respectively) were positive for any of HBV serological markers. The mean ages of HBsAg+ and HBsAg- patients with CAH, LC and HCC were 38.0 and 45.8, 45.6 and 51.2, and 49.5 and 55.5 years, respectively; the differences between HBsAg+ and HBsAg- patients were statistically significant in each CLD (p(0.01). When HBsAg- groups were subdivided into 4 smaller subgroups according to HBV antibody profiles, such differences were not demonstrated among 4 HBsAg- subgroups. Intervals in years between CAH and LC and between LC and HCC were not different according to HBsAg status in the serum. We concluded that the prevalence of present and past HBV infection in patients with CLD in Korea was extremely high, and that HBsAg+ patients developed CLD at a younger age than HBsAg- patients, the reason for which remains to be established.