Long-term clinical and histological outcomes in patients with spontaneous hepatitis B surface antigen seroclearance

Clearance of hepatitis B surface antigen and risk of hepatocellular carcinoma in a cohort chronically infected with hepatitis B virus

“…20 Rates of HBsAg clearance have been similar to the rate we found, ranging from 0.5% to 0.8% per year. 6,16 Similar to our study, older age but not sex was associated with HBsAg seroclearance. 5 One previous case-control study found that persons infected with genotype B had a significantly higher rate of HBsAg clearance than those infected with genotype C. 19 However, based on the geographic distribution of HBV genotypes, genotype B in this study was likely to be B Asia (B2-5), whereas the genotype B found in Alaska Native carriers is a new subtype (B6) that is more closely related to B Japan (B1).…”

“…Some previous prospective studies have been reported following untreated cohorts of patients with chronic hepatitis B who cleared HBsAg 5,6,[16][17][18][19][20] (Table 6). All of these studies have been clinic-based, and ours is the only population-based study.…”

“…Two studies found HBV DNA and even covalently closed circular DNA more frequently in liver biopsies prior to clearance than in sera. 16,23 It is likely that differences in the We were able to determine genotype on 129 persons who cleared HBsAg. We found evidence of HBV DNA in 28 (18%) of these a median of 3.6 years after clearance.…”

“…Liver inflammation and fibrosis has been found to improve over time. 16,17,23 In one study, none of 186 persons who were noncirrhotic and not infected with hepatitis C or D at the time of HBsAg clearance subsequently developed cirrhosis, and all had normal ALT levels an average of 62 months after clearance. 22 However, the risk of developing HCC after HBsAg clearance has not been determined, though others have shown that HCC can still occur years after clearance of HBsAg.…”

“…22 However, the risk of developing HCC after HBsAg clearance has not been determined, though others have shown that HCC can still occur years after clearance of HBsAg. 16,17,22,23 In the study with the highest rate of liverrelated complications after loss of HBsAg, 29.8% at 5 years, including 11 cases of HCC, participants were only followed for a mean of 23 months after HBsAg clearance. 18 It is conceivable that many of these patients may have been incubating HCC tumors at the time of HBsAg clearance.…”