Long-Term Follow-Up of Acute Hepatitis B: New Insights in Its Natural History and Implications for Antiviral Treatment

Abstract

Acute hepatitis B infection (AHB) is still a common viral acute hepatitis worldwide. As vaccination, antiviral treatment, and immigration are bound to affect the epidemiological landscape of HBV infections, and some of its aspects need to be investigated: (1) the circulation of vaccine escape mutants and of primary drug resistant strains; (2) the change in HBV genotype prevalence; and (3) the clinical implications of AHB and the probability of chronification. The serological, virological, and clinical parameters of 75 patients, acutely infected by HBV, were gathered for a retrospective study. Long-term follow up, either to complete seroconversion or for up to five years, was possible for 44 patients. Sequence analysis of the reverse transcriptase/HBsAg and precore regions was performed to investigate the molecular epidemiology and pathogenesis of recent infections by HBV. Genotype distribution in AHB in Italian patients was radically different from that of chronic infections, with a dramatic increase of extra-European genotypes (A1, F), suggesting that a proportion of AHBs are currently related to imported strains. None of the documented infections occurred in vaccinated individuals, while HBsAg variants (potentially vaccine escape variants) were rare and less prevalent than in chronic infections. No drug resistant strains were observed. Spontaneous viral clearance occurred in all but three cases. Time to viral clearance was inversely proportional to liver damage, but HBsAg titer on day 28 and, better still, HBsAg decay from day 0 to day 28 after admission, were the best predictors of chronification. They are, thus, potentially useful to guide antiviral treatment to prevent chronic evolution.

Incidence of hepatitis B virus infection among human immunodeficiency virus-infected treatment naïve adults in Botswana

“…There are limited data on HBsAg clearance rates in HBV incident cases; however, a study in Rome reported an HBsAg clearance rate of about 82% in acute HBV patients. [ 27 ] According to our knowledge, in Botswana, HBsAg clearance has only been reported for chronic HBV patients where 37% of participants on anti-HBV treatment (tenofovir and emtricitabine) over a 2-year period cleared HBsAg. [ 13 ]…”

“…In Italy, AHB is of clinical concern as it most often requires hospital admission sometimes being a threat to the patient's life. It was related to strains from elsewhere, [ 27 ] and this raised concern of treatment of immigrants. Furthermore, Jindal et al [ 46 ] state that reactivation of HBV is associated with immunosuppression and will most often present as AHB, hence the need to further assess predictors of chronicity in these patients, particularly because they are coinfected with HIV.…”

Acute hepatitis B in pregnancy with surprisingly rapid clearance of serum HBs antigen associated with a favourable outcome

“…Although an aggressive cytotoxic response seems to be required for rapid HBsAg clearance, with the drawback of a more intense (albeit transient) parenchymal damage, here we observed rapid HBsAg loss associated with a favourable outcome (no liver injury). Menzo et al indicate that both HBsAg at day 28 and the kinetics of HBsAg in the first four weeks from admission are predictors of the chance of clearing HBsAg within six months (Menzo et al, 2018).…”

“…The previously comparative study (Han et al, 2014) does not specifically mention HBV genotypes, while many studies have shown clinical and biological variations according to the HBV genotype (Revill et al, 2020). For instance, patients infected by genotype D would experience the highest liver alterations and the lowest HBsAg titres (Menzo et al, 2018), but the impact of genotype E has never been investigated. Further studies are needed to investigate the evolution of HBsAg titre according to genotypes.…”

Прогнозування Акушерських Ускладнень У Жінок З Вперше Виявленою Реплікативною Активністю Гепатиту В

“…Не дивлячись на досягнення медицини та постійне впровадження нових медичних технологій у практику з метою контролю над інфекційними процесами, вірусні гепатити є суттєвою причиною підвищення захворюваності та смертності [1][2][3][4]. На сьогодні у світі 1 млрд інфікованих та 350 млн чоловік носіїв вірусу ГВ, які є постійним резервуаром та джерелом інфекції [5].…”