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

Abstract

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

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

“…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.…”

“…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. In our study, HCC occurred in 6 patients a mean of 7.3 years after HBsAg clearance (range, 2.0-15.5 years).…”

Role of viral factors in the natural course and therapy of chronic hepatitis B

“…In contrast, a recent observation indicated an appreciably higher rate of HBsAg seroclearance during a long-term follow-up [14]. HBV carriers in this phase usually confer a favorable prognosis [15]; however, a significant proportion of Asian carriers still develop HCC from a background of cirrhosis [16]. HBV carriers negative for HBeAg were usually thought to have nonreplicative HBV infection, and their serum ALT levels were normal or nearly normal.…”

Chronic hepatitis B

“…7 Clearance of HBsAg decreases the risk of hepatic decompensation and probably HCC, 69,83 but HCC can occur in longterm carriers who have cleared HBsAg. 43,70,84 Coinfection with HCV or human immunodeficiency virus (HIV) is commonly seen in injecting drug users. 5 Coinfection with HIV is also seen in men who have sex with men.…”