J Viral Hepat. 2018 Aug 16. doi: 10.1111/jvh.12978. [Epub ahead of print]
Incidence and determinants of spontaneous HBsAg seroclearance and seroconversion in HBeAg negative chronic infection patients: a population based prospective cohort.
Zhu L1, Zhai X1, Wang Q2, Jiang J1, Peng H1, Song C3, Ge Z3, Qian J1, Zhou M1, Zhou Y2, Xu J4, Liu H5, Hang D3, Hu Z3, Shen H3, Zhu F1.
Author information
1
Jiangsu Province Center for Disease Prevention and Control, Nanjing, China.
2
Zhangjiagang Center for Disease Prevention and Control, Zhangjiagang, China.
3
Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China.
4
Danyang Center for Disease Prevention and Control, Danyang, China.
5
Taixing Center for Disease Prevention and Control, Taixing, China.
Abstract
Seroclearance of hepatitis B surface antigen (HBsAg) has been widely studied, however, seroconversion of HBsAg and characteristics of viral load among HBeAg negative chronic infection patients after HBsAg lost is not clear. We performed a large scale srtudy in a HBeAg negative chronic infection cohort to evaluate spontaneous HBsAg seroclearance incidence from Oct 2012 to April 2017 in Jiangsu province, China. We also elucidated the characteristics of HBsAg seroconversion and HBV DNA detectability among patients who cleared HBsAg. A total of 2,997 HBeAg negative chronic infection patients (mean age 52.3±12.9 years at baseline) were included. With 10,519 person years of follow up, 348 patients successfully spontaneously cleared HBsAg, with an incidence rate of 3.31 per 100 person-years. Patients with HBV DNA detectable ~1999 IU/ml at baseline had a lower probability of HBsAg seroclearance relative to those with undetectable HBV DNA, with a HR of 0.31 (95%CI=0.23, 0.41). HBsAg seroconversion occurred in 37.3% of those patients who cleared HBsAg. The geometric mean of anti-HBs among those with HBsAg conversion was 79.4 mIU/ml. Female had a higher HBsAg seroconversion rate (P=0.011). Among those with HBsAg seroclearance, 11.2% still had HBV-DNA levels of higher than 100IU/mL. Patients with higher HBV DNA at baseline had a higher risk of detectable HBV DNA levels even after HBsAg seroclearance (P<0.001). This study reveals HBsAg seroconversion rates and HBV DNA undetectability epidemiological characteristics of patients with HBsAg seroclearance, and suggests that monitoring HBV DNA is needed when managing HBeAg negative chronic patients, even after clearing HBsAg. This article is protected by copyright. All rights reserved.
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