Naïve hepatitis B e antigen-negative chronic hepatitis B patients are at risk of carotid atherosclerosis: A prospective study

BACKGROUND

There is an increased risk of atherosclerosis in patients with chronic hepatitis C or human immunodeficiency virus, but there is scarce data on hepatitis B virus infection. The hypothesis of this study is that hepatitis B virus infection increases the risk of carotid plaques and subclinical atherosclerosis in naïve hepatitis B e antigen (HBeAg) negative subjects.

AIM

To assess the rate of carotid plaques and subclinical atherosclerosis in naïve HBeAg negative subjects in comparison with a cohort of healthy controls.

METHODS

Prospective case-control collaborative study conducted in two tertiary hospitals. Four hundred and two subjects prospectively recruited at the outpatient clinic were included from May 2016 to April 2017: 201 naïve HBeAg-negative hepatitis B virus-infected [49 chronic hepatitis B (CHB) and 152 inactive carriers(ICs)] and 201 healthy controls. Anthropomorphic and metabolic measures, liver stiffness and carotid Doppler ultrasound were performed. Subclinical atherosclerosis was established on an intima-media thickness increase of ≥1.2 mm and/or the presence of carotid plaques. Normally distributed quantitative variables were compared with the Student t test and those with a non-normal distribution with the Mann-Whitney U test. Categorical variables were compared between groups using the χ² or Fisher exact test.

RESULTS

Carotid plaques were found more often in CHB (32.7%) than ICs (17.1%) or controls (18.4%) (P = 0.048). Subclinical atherosclerosis was also increased in CHB (40.8%) vsICs (19.1%) or controls (19.4%) (P = 0.003). No differences in the risk of atherosclerosis were observed between controls and ICs. The factors independently associated with the presence of carotid plaques were age [odds ratio(OR) 1.43, P < 0.001] and CHB (OR 1.18, P = 0.004) and for subclinical atherosclerosis, age (OR 1.45, P < 0.001), CHB (OR 1.23, P < 0.001) and diabetes (OR 1.13, P = 0.028). In the subset of young subjects (< 50 years), carotid plaques (12.5% vs 1.1%, P = 0.027) and subclinical atherosclerosis (12.5% vs 2.2%, P = 0.058) were more frequent among CHB than ICs.

CONCLUSION

Untreated HBeAg-negative CHB is an independent risk factor for carotid plaques and subclinical atherosclerosis, while ICs present a similar risk to controls.

POS0427 CLINICAL CHARACTERISTICS OF PATIENTS WITH SYSTEMIC SCLEROSIS AND GASTRIC ANTRAL VASCULAR ECTASIA (GAVE)

Background:

Gastric antral vascular ectasia (GAVE) is one of the gastrointestinal (GI) manifestations related to systemic sclerosis (SSc). It can be presented as iron deficiency anemia or even upper gastrointestinal bleeding. GAVE is diagnosed by endoscopy observing an image of confluent vascular ectasias that is oriented longitudinally on the folds of the antrum in the appearance of “watermelon”. The definitive treatment for this manifestation consists in endoscopy guided fulguration when the clinical situation allows it.

Objectives:

The objective was to study a cohort of SSc patients at their first endoscopy. The clinical characteristics, laboratory tests and treatments received from SSc patients with GAVE were compared to those without this GI manifestation.

Methods:

From the cohort of patients with SSc in Hospital Universitari Vall d’Hebron, a total of 269 patients who had undergone at least one endoscopy during follow-up were selected. Twenty seven were diagnosed with GAVE. We compared the clinical, analytical and treatment characteristics of these patients with the remaining 242 who did not present GAVE. The statistical study was carried out using the SPSS 20.0 package (Chicago, IL), a p <0.05 was considered as statistical significance.

Results:

The prevalence of GAVE in SSc patients was 10.0%. Patients with GAVE had a higher median age SSc onset taking into account the first non-Raynaud’s phenomenon (RP) symptom attributable to the disease (56.6 vs 48.0 years, p = 0.001). The median age at first endoscopy was 56.5 years in GAVE group compared with 61.7 in the group without GAVE.

Compared with SSc patients without GAVE, patients with GAVE had a higher prevalence of Barrett’s esophagus (14.8% vs. 3.7%, p = 0.011), intestinal involvement (37% vs. 18.6%, p = 0.024) and a trend towards a lower prevalence of interstitial lung disease (25.9% vs 45.0%, p = 0.057).

No difference was identified in the prevalence of scleroderma renal crisis. Patients with GAVE presented a higher frequency of early or active Cutolo capillaroscopy pattern with a predominance of enlarged capillaries or megacapillaries (84.6% vs 62.4%, p = 0.025), greater frequency of anti-centromere antibodies (63.0% vs. 42.1%, p = 0.039) and a trend towards a lower proportion of anti-topoisomerase I (3.7% vs. 18.6%, p = 0.052). No difference was found in prevalence of anti-RNA polymerase III antibodies between groups. Patients with GAVE were treated less frequently with non-glucocorticoid immunosuppressants prior to diagnostic endoscopy (0% vs 20.2%, p = 0.010). The 33.3% of patients with GAVE were treated with endoscopic fulguration, and 66.7% of them received supplementary treatment with oral iron.

Conclusion:

SSc patients with GAVE had higher age at SSc onset, more frequency of Barrett’s esophagus and intestinal involvement, prevalence of anti-centromere antibodies, early or active Cutolo scleroderma pattern and lower prior non-glucocorticoids treatment.

References:

[1]Ghrénassia E, Avouac J, Khanna D, T.Derk C, Distler O, Suliman Y, et al. Prevalence, Correlates and Outcomes of Gastric Antral Vascular Ectasia in Systemic Sclerosis: A EUSTAR Case-control Study. The Journal of Rheumatology. 2014; 41:1.

Disclosure of Interests:

None declared