Spontaneous loss of hepatitis B surface antigen in chronic carriers, based on a long-term follow-up study in Goto Islands, Japan

Abstract

Annual mass examination was performed between 1972 and 1997 in Tomie-town, Goto Islands, Japan, where hepatitis B virus (HBV) infection is very prevalent. In the present study, the incidence of spontaneous loss of hepatitis B surface antigen (HBsAg) in HBsAg carriers was determined in this area. Three thousand and nineteen inhabitants were tested for HBsAg two or more times in our annual surveys. Among them, 131 (4.3%) were defined as chronic HBsAg carriers based on the persistence of HBsAg for 1 or more years. These 131 subjects were followed for 12.2 +/- 7.6 years. During the follow-up period, spontaneous loss of HBsAg occurred in 38 (29%) of the 131 carriers, with a yearly incidence of 2.5%. This loss was seen more frequently in carriers aged 40 years or more on enrollment than in those aged less than 40 years during the same observation periods (P = 0.0141), irrespective of sex or the results of liver function tests. The values for liver function test results were similar before and after loss of HBsAg in these carriers. Stored serum samples were available for later analysis of HBV-DNA by polymerase chain reaction in 32 carriers with loss of HBsAg. The HBV-DNA sequence was detected in 26 (81%) and 2 of the 32 carriers (6%) before and after loss of HBsAg, respectively. These results indicate that spontaneous loss of HBsAg, largely attributable to clearance of viremia, occurs age-dependently in chronic carriers.

Follow-Up of Chronic Hepatitis B Carriers: A Cross-Sectional Descriptive-Analytical Study

“…During the study, 10 carriers (4%) became HBsAg-negative. In line with this finding, previous studies reported a positive-to-negative seroconversion rate of 2.7% (10), 6% (11), and 3.1% (12).…”

Hbsag seroclearance in the natural history of chronic hepatitis b infection

“…These studies mainly concentrate on documenting the presence or absence of HBV and disease outcome of the patients without case-matching control groups of patients without HBsAg seroclearance. According to the results from several controlled studies [17•, 18,19], the following factors are associated with a higher chance of spontaneous HBsAg seroclearance: increasing age, anti-HBe positivity, HBV genotype A compared with genotype D, and genotype B compared with genotype C. However, gender and liver biochemistry were not the predictive factors for HBsAg seroclearance [19].…”

Cost-Effectiveness Analysis of Antiviral Treatments for HBeAg-Positive Chronic Hepatitis B in Canada

“…A fixed-effect metaanalysis was conducted for studies that reported spontaneous HBsAg loss during long-term follow-up and derived 0.9% transition probability [37,38]. Besides, studies showed that HBsAg clearance under NA treatments is confined to those with an active immune response to HBV, such as HBeAg-positive patients who achieve HBeAg clearance [39].…”

“…Recent studies estimated that baseline HBsAg clearance was 1% to 2% among asymptomatic HBsAg carriers (mostly seropositive for anti-HBe) with a mean age of 33 years [37]. A fixed-effect metaanalysis was conducted for studies that reported spontaneous HBsAg loss during long-term follow-up and derived 0.9% transition probability [37,38].…”