Spontaneous hepatitis B surface antigen clearance in a long-term follow-up study of patients with chronic type B hepatitis. Lack of correlation with hepatitis C and D virus superinfection

Silva, L C Da; Madruga, C. L.; Carrilho, Flair José; Pinho, João Pedro; Sáez‐Alquézar, Amadeo; Santos, Cleusa Lapa; Bassit, Leda; Barreto, Cristine Chaves; Fonseca, Luís; Alves, Venâncio Avancini Ferreira; Leitão, Rui; Vianna, Rodrigo; Cardoso, Rita A.; França, Alex Vianey Callado; Gayotto, L C

doi:10.1007/bf02347619

Cited by 46 publications

(48 citation statements)

References 35 publications

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“…In Brazil, various studies of the prevalence of HBV infection have demonstrated its variability, as it is a country with a large geographic area and cultural, ethnic and socioeconomic diversity, [2,16,17]. The present study confirms the high prevalence of HBeAg-negative disease, conferring to this region an important epidemiological role in the natural history of HBV.…”

Section: Discussionsupporting

confidence: 81%

Characterization of HBeAg-negative chronic hepatitis B in western Brazilian Amazonia

Victoria¹,

Oliveira²,

Victoria³

et al. 2008

Braz J Infect Dis

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The present study was conducted with 55 patients native from western Brazilian Amazonia, who were HBV-DNA positive after seroconversion of HBeAg. It is a descriptive case study, with the patients separated into two groups: with hepatitis and without hepatitis on histological examination. The aim of the present study was to describe the clinical and molecular characteristics of patients who are chronic carriers of HBsAg. The prevalence of hepatitis was 63.64%, with a predominance of males (41.82%) and a mean age of 42.5 years, occurring mostly in natives of the southeast sub-region (32.73%). Time was a variable proportional to the course of the disease and the most frequent symptoms were: dyspepsia, asthenia and loss of libido with the majority of the patients having history of prior contact with HBV or positive family history. Splenomegalia was the most frequent sign (40%). Among the tests, platelet count, serum albumin and prothrombin activity were significant in the diagnosis of hepatitis. Alphafetoprotein was greater in patients with hepatitis, and hepatocellular carcinoma was detected in 3.63% of the patients with hepatic cirrhosis. Three types of HBV genotypes were diagnosed: A, D and F in the samples amplified for gene S. Genotype A (AA) was observed in 54.54% of the cases with hepatitis, in contrast to other studies showing the predominance of genotype F in this region. We observed mutations in 36.36%, with a predominance of the mutations in the core promoter region (31.81%), due to the greater prevalence of genotype A in this study. Key-Words: HBeAg-negative chronic hepatitis B, western Brazilian Amazonia, mutations.Western Brazilian Amazonia is considered a region of high endemicity for hepatitis B virus (HBV), where a large part of the population is infected in perinatal period and during infancy. The prevalence of chronic carriers of HBV surface antigen (HBsAg) in these areas varies between 5% and 15% and approximately 50% to 95% of the population show serologic evidence of past infection with HBV [1,2,3]. Various factors are implicated in the development and outcome of HBV infection, but the progression to chronic hepatitis is proportionally greater in individuals infected by the vertical route or during the perinatal period [4]. Chronic hepatopathies related to HBV are seen in two forms: HBeAg positive and HBeAg negative. The HBeAg-negative chronic forms are represented by two groups of patients: chronic inactive HBsAg carriers and chronic hepatitis B (CHB) patients. The distinction between these two forms is difficult, particularly in patients with biochemical and intermittent virologic activity. It is estimated that in the world there are approximately 350 million inactive HBsAg carriers, and of these, 7% to 30% are infected with mutant forms of HBV, which despite the presence of anti-HBe antibody continue to be HBV-DNA positive [5]. Chronic HBsAg carriers who show HBeAg-negative/antiHBe-positive serologic status and have serum HBV-DNA detectable by PCR and active hepatic disease characterized by ...

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Section: Discussionsupporting

confidence: 81%

Characterization of HBeAg-negative chronic hepatitis B in western Brazilian Amazonia

Victoria¹,

Oliveira²,

Victoria³

et al. 2008

Braz J Infect Dis

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“…Patients in the third phase are usually termed 'inactive carriers' -they are positive for hepatitis B surface antigen (HBsAg) but negative for HBeAg, have normal ALT levels and low serum levels HBV DNA (o10 5 genome copies/ml).…”

Section: Introductionmentioning

confidence: 99%

Does increased body mass index with hepatic steatosis contribute to seroclearance of hepatitis B virus (HBV) surface antigen in chronic HBV infection?

2006

Int J Obes

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Background: Overweight and hepatic steatosis have been increasingly recognized recently. This study aimed to test whether substantial amount of fatty infiltration in liver, which may interfere with cytoplasmic distribution of hepatitis B surface antigen (HBsAg), can contribute to HBsAg seroclearance in HBsAg carriers. Methods: Clinical and laboratory data including ultrasound grading of hepatic steatosis were studied in 54 HBsAg carriers with HBsAg seroclearance, and the results were compared with 108 age-and sex-matched carriers with HBsAg persistence. Results: Body mass index and ultrasound grading of hepatic steatosis were significantly higher in HBsAg carriers with HBsAg seroclearance than in those with HBsAg persistence. The degrees of hepatic steatosis correlated significantly with body mass index (Po0.001). The prevalence of mild hepatic steatosis showed no significant difference (33% (18/54) vs 31% (33/108), P ¼ 0.72), but moderate-severe hepatic steatosis was significantly more prevalent in patients with HBsAg seroclearance (33% (18/54) vs 13% (17/108), P ¼ 0.01). HBsAg carriers with moderate and severe hepatic steatosis were associated with a 3.2-fold (95% confidence interval: 1.2-8.4, P ¼ 0.02) and 3.9-fold (95% confidence interval: 1.1-14.2, P ¼ 0.04), respectively, increased odds of HBsAg seroclearance compared to those without hepatic steatosis. Conclusion: Moderate-severe hepatic steatosis may contribute to HBsAg seroclearance in HBsAg carriers.

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“…As had been reported, delayed clearance of serum HBsAg in the natural history of patients with chronic HBV infection was considered an unusual event globally. Its incidence has been estimated to be 0.4% to 2% per year in Western countries, [1][2][3] where HBV infection usually occurs in adults. [1][2][3][4][5][6][7][8][9] In Taiwan, an endemic area of HBV infection that usually occurs perinatally or during early childhood, 10,11 the annual incidence was comparably low, ranging from 0.1% to 0.8%.…”

mentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9] In Taiwan, an endemic area of HBV infection that usually occurs perinatally or during early childhood, 10,11 the annual incidence was comparably low, ranging from 0.1% to 0.8%. 12,13 Although several investigators reported a good prognosis for such patients, 1,3,6,14 some reports suggested that cirrhosis may still develop in spite of HBsAg clearance, and some other patients may even progress to hepatocellular carcinoma (HCC). 7,15 These results implied that these patients might represent a heterogeneous group in the disease spectrum.…”

mentioning

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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Spontaneous hepatitis B surface antigen clearance in a long-term follow-up study of patients with chronic type B hepatitis. Lack of correlation with hepatitis C and D virus superinfection

Cited by 46 publications

References 35 publications

Characterization of HBeAg-negative chronic hepatitis B in western Brazilian Amazonia

Characterization of HBeAg-negative chronic hepatitis B in western Brazilian Amazonia

Does increased body mass index with hepatic steatosis contribute to seroclearance of hepatitis B virus (HBV) surface antigen in chronic HBV infection?

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

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