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Hepatitis B surface antigen levels after hepatitis B e-antigen seroclearance: a longitudinal follow-up study

Authors

  • James Fung,

    1. Department of Medicine, The University of Hong Kong, Hongkong, China
    2. State Key Laboratory for Liver Research, The University of Hong Kong, Hongkong, China
    3. Liver Transplant Centre, Queen Mary Hospital, Hongkong, China
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  • Wai-kay Seto,

    1. Department of Medicine, The University of Hong Kong, Hongkong, China
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  • Danny Ka-ho Wong,

    1. Department of Medicine, The University of Hong Kong, Hongkong, China
    2. State Key Laboratory for Liver Research, The University of Hong Kong, Hongkong, China
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  • Ching-lung Lai,

    1. Department of Medicine, The University of Hong Kong, Hongkong, China
    2. State Key Laboratory for Liver Research, The University of Hong Kong, Hongkong, China
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  • Man-fung Yuen

    Corresponding author
    1. Department of Medicine, The University of Hong Kong, Hongkong, China
    2. State Key Laboratory for Liver Research, The University of Hong Kong, Hongkong, China
    • Correspondence

      Prof Man-Fung Yuen, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam Rd, Hong Kong SAR, China

      Tel: (852) 2255 3984

      Fax: (852) 2816 2863

      e-mail: mfyuen@hkucc.hku.hk

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Abstract

Background & Aims

The role of quantitative hepatitis B surface antigen (HBsAg) after hepatitis B e-antigen (HBeAg) seroclearance is not well defined. To determine the role of HBsAg levels in predicting significant viremia and hepatitis flares after HBeAg seroclearance.

Methods

A total of 228 chronic hepatitis B patients with spontaneous HBeAg seroclearance were included. Patients were followed up regularly at 3–6 monthly intervals with routine liver biochemistry and hepatitis B serology. Levels of HBV DNA and HBsAg were measured at yearly intervals for up to 5 years after HBeAg seroclearance.

Results

The median log HBsAg and HBV DNA level after HBeAg seroclearance was 3.52 IU/ml and 4.13 IU/ ml respectively, with no significant correlation observed between them (P = 0.572). The HBV DNA at HBeAg seroclearance was 4.13 log IU/ml, compared with 3.12 log IU/ml after 5 years (P < 0.001). No significant change was observed for HBsAg levels (P = 0.991). Hepatitis B flares occurred in 76 (33.3%) patients. Patients who developed hepatitic flares compared with those without hepatitic flares were older (40 vs. 36 years, P = 0.001), had a higher HBV DNA at the time of HBeAg seroclearance (4.70 vs. 3.77 log IU/ml, P =< 0.001), and more likely to be males (42.7% vs. 23.4%, P = 0.002) respectively. There was no difference in HBsAg levels between those with and without hepatitis flare (3.54 vs. 3.52 log IU/ml respectively, P = 0.555).

Conclusion

HBV DNA levels, but not HBsAg levels, after HBeAg seroclearance were associated with subsequent significant viremia and hepatitic flares. Male gender and older age was associated with significant viremia.

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