Editorial: metabolic syndrome delays HBeAg seroclearance in Chinese patients with hepatitis B – authors' reply

Abstract

They pointed out the relevance of the interaction between metabolic syndrome and chronic hepatitis B (CHB), given the prevalence of the two diseases and the confounding effect of the age of patients.Our study of 413 hepatitis B e antigen (HBeAg)-positive, treatment-na€ ıve patients were split into three groups of varying metabolic risks.2 The patients with metabolic risk factors (pre-MetS and MetS groups), despite being older compared with the normal group, had comparable baseline viral load, alanine aminotransferase level and genotype distribution which are all critical factors associated with delayed HBeAg seroconversion. To tackle the confounding effect of age, we chose age at HBeAg seroclearance as the time variable in the Cox regression analysis. This would avoid any younger patients entering the study with a longer follow-up without HBeAg seroclearance being censored and an older patient with HBeAg seroclearance within a short follow-up. We agree with the need to control key variables such as age and gender to tease out the specific interaction between obesity-related features and chronic hepatitis B. This would involve an age and gender-matched cohort with younger age patients and longer follow-up. The low prevalence of hepatitis B infection in the era of hepatitis B vaccine would make such studies difficult, and the prevalence of metabolic syndrome in younger patients would be low.Further studies should also investigate the effect of adipokines on viral clearance and validate the study findings in other populations. 3, 4ACKNOWLEDGEMENT The authors' declarations of personal and financial interests are unchanged from those in the original article.