Rates of Hepatitis B Seroclearance Among Patients with Chronic Infection
Atif Zaman, MD, MPH reviewing Yeo YH et al. Gastroenterology 2018 Oct 17
HBV clearance rates are low regardless of therapy receipt, and being seropositive for hepatitis B e antigen slows that even further.
Current hepatitis B virus (HBV) therapy is effective at viral suppression but not viral clearance. Reported rates of spontaneous and treatment-induced viral clearance vary in the current literature. This systematic review and meta-analysis attempts a more precise estimate.
Reviewers searched databases to identify studies that reported hepatitis B surface antigen (HBsAg) seroclearance in HBV-infected patients who were followed for at least 1 year and had at least one HBsAg testing performed during follow-up. Cumulative HBsAg seroclearance incidence was determined at 5, 10, and 15 years using a random-effects model.
Thirty-four articles were included in the meta-analysis, comprising 42,588 patients; 22 of the 34 studies were felt to be at low risk for bias. A total of 3194 patients experienced HBsAg seroclearance during over 300,000 person-years of follow-up. The pooled annual rate was 1% and the 5-, 10-, and 15-year rates were 4%, 8%, and 18%, respectively. Seroclearance rates were similar regardless of HBV genotype status, receipt of HBV treatment, or cirrhosis status. However, hepatitis B e antigen (HBeAg)-negative patients had an over threefold higher seroclearance rate than HBeAg-positive patients (1.3% vs. 0.4%).
Comment
Although there was significant heterogeneity across the studies, this comprehensive meta-analysis, which included recent data, was able to give precise estimates of seroclearance. It clearly shows that HBsAg seroclearance is rare whether or not patients receive HBV treatment, which means that patients will require lifelong suppressive therapy. This study highlights the importance of future research to identify novel curative agents for the treatment of chronic HBV infection. Until then, clinicians should continue to advise their patients that HBV treatment is lifelong.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made. 作者: StephenW 时间: 2018-11-6 21:29