HBsAg Clearance in Patients with Long-Standing Chronic Active Hepatitis B and Hepatitis B Virus-Induced Liver Cirrhosis

Poralla, T.; Manns, Michael P.; Hütteroth, T. H.; Heß, Georg; Dormeyer, H. H.; Büschenfelde, K.-H. Meyer zum

doi:10.1159/000199274

Cited by 15 publications

(10 citation statements)

References 6 publications

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“…4,11,14,15 We found the rate of HBsAg disappearance to be within the reported range at 0.79%/year in HBsAg carriers in Okinawa, Japan, an area highly endemic for HBV infection. 8 Although there was a higher frequency (10.7%) of HBsAg disappearance in a report of 65 cases of chronic hepatitis B, 23 our data, including these previous reports, showed that natural disappearance of HBsAg was an unusual event in subjects with chronic HBV infection.…”

Section: Discussionsupporting

confidence: 43%

Hepatitis B surface antigen disappearance and hepatitis B surface antigen subtype: a prospective, long-term, follow-up study of Japanese residents of Okinawa, Japan with chronic hepatitis B virus infection.

Furusyo¹,

Hayashi²,

Sawayama³

et al. 1999

The American Journal of Tropical Medicine and Hygiene

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Abstract. To determine the natural course of hepatitis B surface antigen (HBsAg) disappearance in chronic hepatitis B virus (HBV) infection and the factors related to its disappearance, 946 HBsAg carriers in Okinawa, Japan were prospectively followed for up to 19 years (mean ϭ 9.2 years). The disappearance of HBsAg, as determined by radioimmunoassay (RIA), was observed in 62 (6.6%) and the overall annual disappearance rate was 0.79%/year. Its disappearance was more frequent in 60 (7.4%) of 815 serum samples negative for hepatitis B e antigen (HBeAg) by RIA at entry compared with only two (1.5%) of 131 serum samples that were HBeAg positive by RIA at entry (P Ͻ 0.05). Stepwise logistic regression analysis showed that age and HBsAg subtype were significantly associated with HBsAg disappearance (both P Ͻ 0.05), and that carriers with subtype adr (odds ratio ϭ 2.87) had an increased probability of clearing HBsAg compared with carriers with subtype adw. Conversely, HBeAg disappearance was earlier in those with the adw subtype than in those with adr. Hepatitis B virus DNA was not detected by the polymerase chain reaction after HBsAg disappearance in any of the 62 from whom it had disappeared. The HBsAg titer, as measured by reverse passive hemagglutination, was related to the time to its disappearance; the higher the titer, the longer the time to disappearance. These findings suggest that HBeAg negativity, a more advanced age, and low titers of HBsAg are favorable factors for HBsAg disappearance in the natural course of chronic HBV infection. Moreover, HBsAg subtype adr was a predictive factor for HBsAg disappearance, whereas subtype adw was predictive of early HBeAg disappearance.It has been conservatively estimated that there are 350 million chronic hepatitis B virus (HBV) carriers throughout the world.1 This virus is a serious problem in many countries since it causes chronic liver disease and hepatocellular carcinoma. [2][3][4] Diagnosis is made by the detection of hepatitis B surface antigen (HBsAg) in serum. The disappearance of HBsAg and the appearance of antibody to HBsAg (anti-HBs) in sera have been reported to indicate the clearance of HBV particles and the cessation of hepatocyte injury. [5][6][7] Our laboratory previously reported that the Yaeyama District of Okinawa, Japan was highly endemic for HBV infection, 8 and that the number of newly infected residents has decreased there, as estimated in our long-term study. 9 In another Okinawa study, we found that the rate and age of seroconversion from hepatitis B e antigen (HBeAg) to antibody to HBeAg (anti-HBe) were higher and younger in cases with the HBsAg subtype adw than in those with subytpe adr, suggesting that the HBsAg subtype may be closely associated with the HBeAg/anti-HBe status.

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Section: Discussionsupporting

confidence: 43%

Hepatitis B surface antigen disappearance and hepatitis B surface antigen subtype: a prospective, long-term, follow-up study of Japanese residents of Okinawa, Japan with chronic hepatitis B virus infection.

Furusyo¹,

Hayashi²,

Sawayama³

et al. 1999

The American Journal of Tropical Medicine and Hygiene

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“…Spontaneous HBsAg clearance has been observed in patients who exhibit cirrhosis or after HCC resection, 4,7,8,12,13 but the mechanism of clearance of HBsAg remains unclear. Although superinfection of HCV in HBsAg carriers Ͼ35 years was reported to be closely associated with this phenomenon, 26 HCV infection accounted for only a minority of such subjects, and more than half of our patients had no evidence of superinfection of other viruses.…”

Section: Discussionmentioning

confidence: 99%

Sero-clearance of hepatitis B surface antigen in chronic carriers does not necessarily imply a good prognosis

et al. 1998

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The incidence of delayed hepatitis B surface antigen (HBsAg) clearance in the natural history of chronic hepatitis B virus (HBV)-infected patients was low. Previous studies regarding the prognosis in such patients were controversial. Among 1,355 chronic carriers from 1985 to 1997, spontaneous HBsAg clearance was observed in 55 patients. During a mean follow-up period of 23 months, 18 (32.7%; all were male subjects) developed serious complications, including 11 with hepatocellular carcinoma (HCC) (9 of them underwent surgical resection), 6 with cirrhosis, and 1 with subfulminant liver failure. The overall cumulative probability of complications was 29.8% at 4 years, and it was higher in males (P ‫؍‬ .044) and patients aged 45 years or more (P ‫؍‬ .006); the latter carried an 8.6-fold increased risk (95% CI: 1.2-64.6; P ‫؍‬ .037) of adverse events. Histories of acute or chronic infection by hepatitis

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“…Moreover, there are evidences about clearance of serum HBsAg also in pa tients with chronic active hepatitis, surely related to HBV infection and with HBsAgpositive liver cirrhosis [10,16], and also after resection of HBsAg-positive hepatocel lular carcinoma [23], The use of monoclonal antibodies to detect serum HBs.Ag produced an increase in the sensitivity of the conven tional assays [ 19,20]. In our study, we tried to correlate liver HBV markers to the pres ence of serum HBsAg detected by M-EIA.…”

Section: Discussionmentioning

confidence: 99%

Cryptogenic Chronic Liver Disease and Serum or Liver Hepatitis B Virus Markers

Diodati¹,

Pontisso²,

Bonetti³

et al. 1988

Digestion

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In an attempt to evaluate a possible correlation between cryptogenic chronic liver disease and a present or past hepatitis B virus (HBV) infection, we studied 17 patients with hepatitis B surface antigen (HB_sAg)-negative, nonalcoholic chronic liver disease; 9 of them were positive for serum HB_sAg detected by a solid-phase enzyme immunoassay with monoclonal antibody (M-EIA) and 8 were negative for the same marker. Liver hepatitis B core antigen (HB_cAg), studied by an indirect immunofluorescence technique, was present in 55.5% of the patients positive for serum HB_sAg by M-EIA. In the same group of patients, liver HBV-DNA was found in 66.6% of the patients. On the other hand, only 1 patient without serum positivity for HB_sAg by M-EIA was positive for liver HB_cAg and HBV-DNA. None of our patients showed serum positivity for HBV-DNA sequences. We conclude that HBV infection may be a possible cause of cryptogenic chronic liver disease; this HBV-related, HB_sAg-negative chronic liver disease seems to have no viral replication or undetectable levels of HBV-DNA in serum. HB_sAg, detected by a monoclonal assay, seems to be a suitable marker to identify this subgroup of patients with HB_sAg-negative chronic liver disease.

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HBsAg Clearance in Patients with Long-Standing Chronic Active Hepatitis B and Hepatitis B Virus-Induced Liver Cirrhosis

Cited by 15 publications

References 6 publications

Hepatitis B surface antigen disappearance and hepatitis B surface antigen subtype: a prospective, long-term, follow-up study of Japanese residents of Okinawa, Japan with chronic hepatitis B virus infection.

Hepatitis B surface antigen disappearance and hepatitis B surface antigen subtype: a prospective, long-term, follow-up study of Japanese residents of Okinawa, Japan with chronic hepatitis B virus infection.

Sero-clearance of hepatitis B surface antigen in chronic carriers does not necessarily imply a good prognosis

Cryptogenic Chronic Liver Disease and Serum or Liver Hepatitis B Virus Markers

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