Clinical features of HBsAg loss in HBV carriers charted
medwireNews: A study published in the World Journal of Gastroenterology pinpoints the factors associated with hepatitis B surface antigen (HBsAg) seroclearance in Korean hepatitis B virus (HBV) carriers, and also describes the outcomes of these individuals.
“The results of our study may facilitate the design of a management strategy for HBV carriers both pre- and post-HBsAg seroclearance,” say Young Min Park and Seong Gyu Lee, both from Bundang Jesaeng General Hospital in Seongnam-si, South Korea.
Among 1919 HBV carriers seen at their institution between 2003 and 2015, 4.7% achieved HBsAg loss over an average of 6.2 years, with four factors significantly associated with the time to HBsAg seroclearance.
The first of these was the HBsAg signal-to-cutoff ratio (SCR), a qualitative assessment of HBsAg levels based on the signal intensity of an antigen–antibody reaction. Specifically, the time from study entry to HBsAg loss was significantly shorter for individuals with an SCR below versus at or above 1000, at an average of 5.07 and 7.47 years, respectively (p=0.0008). And a sequential decrease in the SCR predicted HBsAg seroclearance “in every case,” say the researchers.
Given the high cost of quantitative HBsAg assessment, they believe that sequential HBsAg-SCR data could be “very useful for the long-term management of carriers.”
Time to HBsAg loss was also significantly shorter for individuals with HBV DNA levels below 20 IU/mL than above 2000 IU/mL (mean 4.92 vs 8.31 years; p=0.0005), and also for those with normal findings on liver ultrasonography relative to the presence of noncirrhotic chronic liver disease or cirrhosis (mean 5.05 vs 6.86 and 6.80 years, respectively; p=0.0259 and 0.0366, respectively).
Hepatitis B e antigen (HBeAg)-negativity also correlated with a shorter time to HBsAg seroclearance, but the association was only significant for individuals aged between 40 and 59 years (mean 6.18 vs 9.24 years, p=0.013).
Seven of the 90 individuals with HBsAg seroclearance presented with hepatocellular carcinoma (HCC) at study entry, while six developed HCC during follow-up, in four cases after achieving HBsAg loss.
This equates to a rate for progression to HCC after seroclearance of 4.8%, and indicates that HBsAg seroclearance does not guarantee protection from HCC, say Park and Lee
Noting that approximately a third of the HBV carriers who achieved HBsAg negativity had asymptomatic liver cirrhosis at study entry, they conclude: “Spontaneous HBsAg loss might occur in a large proportion of cryptogenic [liver cirrhosis] and HCC cases in Korea, and surveillance should be continued after HBsAg loss in the same manner as for HBsAg-positive patients.”
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