TRAJECTORIES OF HEPATITIS B SURFACE ANTIGEN AND
ASSOCIATIONS WITH HEPATOCELLULAR CARCINOMA, LIVER
CIRRHOSIS, AND HBsAg SEROCLEARANCE AMONG CHRONIC
HEPATITIS B CARRIERS WITH LOW VIRAL LOADS
J. Liu1, H.-I Yang1, M.-H. Lee2, R. Batrla-Utermann3, C.-L. Jen1,
S.-N. Lu4, L.-Y. Wang5, S.-L. You1, C.-J. Chen1. 1Academia Sinica
Genomics Research Center, 2Institute of Clinical Medicine, National
Yang-Ming University, Taipei, Taiwan; 3Roche Diagnostics, Basel,
Switzerland; 4Gastroenterology, Chang-Gung Memorial Hospital,
Kaohsiung, 5MacKay College of Medicine, Taipei, Taiwan
E-mail: [email protected]
Background and Aims: Chronic hepatitis B virus (HBV) carriers
with low viral loads have significantly decreased risk for
hepatocellular carcinoma (HCC) and liver cirrhosis, and are more
likely to reach HBsAg seroclearance. Previous studies have shown
that baseline serum hepatitis B surface antigen (HBsAg) levels can
help to predict HBV-related outcomes, but the role of long-term
trajectories of quantitative HBsAg is still unclear. This study aims to
examine the role of HBsAg trajectories in predicting HCC, cirrhosis,
and HBsAg seroclearance among chronic HBV carriers with low
viral loads.
Methods: A total of 1204 individuals from the community-based
REVEAL-HBV cohort were included in this study. Participants had
viral loads <10,000 copies/mL with normal ALT, and were HBeAgseronegative,
anti-HCV seronegative, and free of cirrhosis at study
entry. All participants had >2 measurements of quantitative HBsAg,
and trajectories were measured by calculating the decline in HBsAg
levels per year of follow-up. The median decrease, 0.059 log iu/mL
per year, was used as a cut-off.
Results: Among 1204 individuals with HBVDNA <10,000 copies/mL,
the mean (range) baseline HBsAg level was 2.06 (−2.0–4.8) log
iu/mL. Compared to those with baseline HBsAg levels <2 log iu/mL,
those with HBsAg levels ≥2 log iu/mL had similar rates of
HBsAg decline during follow up (P = 0.33). Compared to those
without significant declines in HBsAg levels (<0.059 log iu/mL per
year) during follow-up, individuals with declines in HBsAg levels
≥0.059 log iu/mL per year had adjusted rate ratios (95% CI, p-value)
for HCC, liver cirrhosis, and HBsAg seroclearance of 1.68 (0.66–4.26,
p = 0.28), 0.78 (0.48–1.29, p = 0.33), and 1.86 (1.49–2.32, p < 0.001),
respectively. Furthermore, compared to those with baseline HBsAg
levels ≥100 iu/mL, those with baseline HBsAg levels (iu/mL) and
follow-up declines (log iu/year) of <100/<0.059, and <100/≥0.059
had adjusted HBsAg seroclearance rate ratios (95% CI, p-value)
of 4.44 (3.43–5.75, p < 0.001), and 7.85 (5.85–10.55, p < 0.001),
respectively.
Conclusions: Among chronic hepatitis B patients with low viral
loads, decreases in HBsAg levels did not further significantly
reduce rates of HCC or cirrhosis, but did significantly predict
HBsAg seroclearance. Further clarification of the role of long-term
quantitative HBsAg trajectories in the natural history of chronic
hepatitis B infection is needed 作者: StephenW 时间: 2015-5-14 13:31
