Saudi Journal of Gastroenterology
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Year : 2019  |  Volume : 25  |  Issue : 2  |  Page : 141
Chronic hepatitis B patients: A relation of age and comorbidities

Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India

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Date of Web Publication20-Mar-2019

How to cite this article:
Vyas AK, Singh AK. Chronic hepatitis B patients: A relation of age and comorbidities. Saudi J Gastroenterol 2019;25:141

How to cite this URL:
Vyas AK, Singh AK. Chronic hepatitis B patients: A relation of age and comorbidities. Saudi J Gastroenterol [serial online] 2019 [cited 2019 Dec 15];25:141. Available from:


I read with great interest the article by Sanai et al.[1] recently published in this Journal. The authors utilized data from the Systematic Observatory Liver Disease Registry (SOLID), from the Liver Disease Research Center based in Saudi Arabia. In this observational retrospective study authors reported that chronic hepatitis B (CHB) patients in Saudi Arabia were older in 2015 compared to 2010 and 2012.[1] The study showed that older patients had a higher chance to develop comorbidities, including cirrhosis, hepatocellular carcinoma (HCC), coronary artery disease (CAD), and exhibited a greater likelihood to have been treatment experienced or undergone treatment switch.

The authors noted that the study has many limitations due to data availability. However, in addition to the authors-listed limitations, I would like to highlight certain issues that may serve to confound the findings of the study. First, understanding the status of chronic hepatitis B virus (HBV) infection phases (inactive carrier, active, immune tolerant, and reactivation) is important for analyzing the pathogenesis of liver disease progression.[2] Second, according to the current knowledge and largest study to date, the pathogenesis is directly proportional to the HBV DNA level.[3] Both these factors have not been elaborated upon by the authors and are crucial in understanding disease-related outcomes. Third, comorbidities depend on many factors such as immune status, sex, age of patients and specifically in the case of CHB, the HBeAg status. Previous studies have shown that higher HBeAg levels inhibit the immunity.[4]

Notwithstanding the above, we concur with the authors that older age and male gender are well established factors that carry higher risk of HCC. Despite the study limitations mentioned above, it would provide deeper insight towards our understanding of the associated factors for CHB-related pathogenesis, if authors had included the status of immunity, viral load, HBeAg status along with the age of the patients.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Sanai FM, Alghamdi H, Alswat KA, Babatin MA, Ismail MH, Alhamoudi WK, et al. Greater prevalence of comorbidities with increasing age: Cross-sectional analysis of chronic hepatitis B patients in Saudi Arabia. Saudi J Gastroenterol 2019. doi: 10.4103/sjg.SJG_447_18.  Back to cited text no. 1
Kim GA, Lim Y-S, Han S, Choi J, Shim JH, Kim KM, et al. High risk of hepatocellular carcinoma and death in patients with immune-tolerant-phase chronic hepatitis B. Gut 2018;67:945-52.  Back to cited text no. 2
Chen CJ, Yang HI, Su J, Jen CL, You SL, Lu SN, et al. Risk of hepatocellular carcinoma across a biological gradient of serum hepatitis B virus DNA level. JAMA 2006;295:65-73.  Back to cited text no. 3
Zou ZQ, Wang L, Wang K, Yu JG. Innate immune targets of hepatitis B virus infection. World J Hepatol 2016;8:716-25.  Back to cited text no. 4

Correspondence Address:
Dr. Ashish K Vyas
Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sjg.SJG_128_19

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