The authors were interested in the effects of long-term antiviral therapy on survival for chronic hepatitis B (CHB). They performed an ongoing cohort study to assess the probability of survival and factors affecting survival in 1951 Caucasian CHB patients, with or without compensated cirrhosis and without hepatocellular carcinoma (HCC) at baseline, who received long-term entecavir/tenofovir therapy (≥12 months). The 1-, 5- and 8-year cumulative probabilities were 99.7, 95.9 and 94.1% for overall survival; 99.9, 98.3 and 97.4% for liver-related survival; and 99.9, 97.8 and 95.8% for transplantation-free liver-related survival, respectively. The authors found that overall mortality was independently associated with older age and development of HCC, while liver-related mortality was associated with development of HCC only, and transplantation-free liver-related mortality was independently associated with development of HCC and lower platelet levels at baseline. Baseline cirrhosis was not found to be independently associated with any type of mortality. Mortality was not significantly different in all CHB patients compared with the general population (standardised mortality ratio [SMR] 0.82), but it was lower in patients without HCC regardless of baseline cirrhosis (SMR 0.58) and was higher in patients who developed HCC (SMR 3.09). Therefore Caucasian patients with CHB and compensated liver disease who receive long-term entecavir/tenofovir therapy have excellent overall and liver-related 8-year survival, similar to that of the general population. HCC is the main factor that affects their overall mortality and is the only factor that affects their liver-related mortality.
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