Long‐term outcome of inactive and active, low viraemic HBeAg‐negative‐hepatitis B virus infection: Benign course towards HBsAg clearance

Abstract

Viraemia persistently ≤20 000-IU/mL predicts a benign clinical outcome: it was associated with transition to IC in 43% of LV-AC and to Occult HBV Infection in 20% of IC within 5-years. Nevertheless, 13.1% of individuals with low viraemia at presentation develops CHB within 1 year: 1-year HBV-DNA monitoring resulted the most accurate diagnostic approach that can be limited to at least a half of cases by the single point HBV-DNA/HBsAg quantification. The IC-diagnostic-accuracy combining HBV-DNA/total-anti-HBc/HBcrAg needs to be confirmed in further studies.

Editorial: grey zone, a new area of interest in chronic hepatitis B

“…These excellent outcomes after a long‐term follow‐up in patients of this “GZ new category” are encouraging, since this scenario is frequently seen in clinical practice . Olivieri et al report similar results in a recent study and defined this group with HBV‐DNA ≤20.000 IU/mL as low‐viraemic active carriers (LV‐AC) . In this report, 43.5% of LV‐AC became IC, 54.3% remained stable in this phase and only one patient (2.2%) progressed to the chronic hepatitis phase.…”

“…In this report, 43.5% of LV‐AC became IC, 54.3% remained stable in this phase and only one patient (2.2%) progressed to the chronic hepatitis phase. No major liver‐related events were reported during the study …”

“…There are no baseline factors helping in predict outcomes. Bonacci et al found higher HBsAg levels in GZ than in IC, and Olivieri et al propose a cut‐off value of 1000 IU/mL to predict virological outcomes in patients with HBV DNA <20.000 IU/mL . Also, HBsAg levels <100‐1000 IU/mL where proposed for defining IC with good long‐term outcomes …”

Anti‐viral therapy can be delayed or avoided in a significant proportion of HBeAg‐negative Caucasian patients in the Grey Zone

“…In summary, our results show that Caucasian GZ patients present excellent outcomes after a long-term follow-up, which is in line with a recent study in HBeAg-negative patients with low replication. 37 Indeed, development of active hepatitis was rare, whereas beneficial events such as loss of HBsAg or transition into the inactive carrier state were frequent, mainly among patients infected with genotype A or D. Fluctuation of ALT and/or HBV-DNA was frequent but did not prevent a favourable outcome in the vast majority of patients.…”

Serum hepatitis B core‐related antigen is an effective tool to categorize patients with HBeAg‐negative chronic hepatitis B

“…Even if the virological determinants underlying these kinetics are not clear, the long‐term monitoring of patients in clinical practice demonstrated that putative CIB undergoes the same outcome of true CIB, despite a lower frequency of HBsAg loss/seroconversion. This observation, which confirms recent data, is well described by the measurement of HBcrAg.…”