Long-term outcome in Caucasian patients with chronic hepatitis B virus infection after HBsAg seroclearance

Authors

  • Eugenia Lauret,

    1. Liver Unit, Division of Gastroenterology and Hepatology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
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  • María L. González-Diéguez,

    1. Liver Unit, Division of Gastroenterology and Hepatology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
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  • Mercedes Rodríguez,

    1. Virology Unit, Department of Microbiology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
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  • Marta González,

    1. Department of Pathology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
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  • Santiago Melón,

    1. Virology Unit, Department of Microbiology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
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  • Luis Rodrigo,

    1. Liver Unit, Division of Gastroenterology and Hepatology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
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  • Manuel Rodríguez

    Corresponding author
    1. Liver Unit, Division of Gastroenterology and Hepatology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
    • Correspondence

      Dr. Manuel Rodríguez, MD, Liver Unit, Division of Gastroenterology and Hepatology, Hospital Universitario Central de Asturias, Celestino Villamil s/n, Oviedo, Asturias 33006, Spain

      Tel/Fax: + 34 985 273614

      e-mail: manurodrigg@gmail.com

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Abstract

Background & Aims

The natural course after hepatitis B surface antigen (HBsAg) seroclearance in Caucasian patients with chronic hepatitis B virus (HBV) infection is not well-defined. To investigate the clinical characteristics and outcome in a series of European Caucasian patients with chronic HBV infection according to HBsAg response over time.

Methods

A total of 612 patients with compensated chronic HBV infection and without other cause of liver disease were prospectively followed up. Seventy-eight subjects cleared HBsAg and 534 remained HBsAg-positive. Clinical and virological examinations were periodically performed and development of cirrhosis and liver-related complications was monitored during a mean follow-up time of 9.9 years.

Results

After HBsAg seroclearance, serum HBV DNA was undetectable in 38 patients in whom it was tested and HBsAg reappearance was observed in two subjects (2.6%). At 15 years of follow-up, the cumulative probability of developing a liver-related complication was 11.6% in HBsAg-positive patients and 1.8% in those with HBsAg loss (P = 0.03), although this benefit was limited to patients with cirrhosis (P < 0.001) and to those who received therapy (P < 0.01). Among patients without cirrhosis and among those who did not receive therapy, the probability was not different between those who cleared the HBsAg and those who did not (P = 0.3 and P = 0.5 respectively).

Conclusion

Hepatitis B surface antigen loss confers a significant clinical benefit in Caucasian subjects with HBV-related cirrhosis and in those with chronic HBV infection who receive antiviral therapy. However, HBsAg reappearance can be observed in selected cases.

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