Factors Associated With Rates of HBsAg Seroclearance in Adults With Chronic HBV Infection: A Systematic Review and Meta-analysis
Yee Hui Yeo
, Hsiu J. Ho
, Hwai-I Yang
, Tai-Chung Tseng
, Tetsuya Hosaka
, Huy N. Trinh
, Min-Sun Kwak
, Young Min Park
, James Yan Yue Fung
, Maria Buti
, Manuel Rodríguez
, Sombat Treeprasertsuk
, Carmen Monica Preda
, Teerapat Ungtrakul
, Phunchai Charatcharoenwitthaya
, Xiangyong Li
, Jiayi Li
, Jian Zhang
, Michael Huan Le
, Bin Wei
, Biyao Zou
, An Le
, Donghak Jeong
, Nicholas Chien
, Leslie Kam
, Chiao-Chin Lee
, Mar Riveiro-Barciela
, Doina Istratescu
, Tassanee Sriprayoon
, Yutian Chong
, Tawesak Tanwandee
, Mariko Kobayashi
, Fumitaka Suzuki
, Man-Fung Yuen
, Hyo-Suk Lee
, Jia-Horng Kao
, Anna S. Lok
, Chun-Ying Wu'Correspondence information about the author Chun-Ying WuEmail the author Chun-Ying Wu
, Mindie H. Nguyen'Correspondence information about the author Mindie H. NguyenEmail the author Mindie H. Nguyen
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DOI: https://doi.org/10.1053/j.gastro.2018.10.027 |
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Background & Aims
Seroclearance of hepatitis B surface antigen (HBsAg) is a marker for clearance of chronic hepatitis B virus (HBV) infection, but reported annual incidence rates of HBsAg seroclearance vary. We performed a systematic review and meta-analysis to provide more precise estimates of HBsAg seroclearance rates among subgroups and populations.
Methods
We searched PubMed, Embase, and the Cochrane library for cohort studies that reported HBsAg seroclearance in adults with chronic HBV infection with more than 1 year of follow-up and at least 1 repeat test for HBsAg. Annual and 5-, 10-, and 15-year cumulative incidence rates were pooled using a random effects model.
Results
We analyzed 34 published studies (with 42,588 patients, 303,754 person-years of follow-up, and 3194 HBsAg seroclearance events), including additional and updated aggregated data from 19 studies. The pooled annual rate of HBsAg seroclearance was 1.02% (95% CI, 0.79–1.27). Cumulative incidence rates were 4.03% at 5 years (95% CI, 2.49–5.93), 8.16% at 10 years (95% CI, 5.24–11.72), and 17.99% at 15 years (95% CI, 6.18–23.24). There were no significant differences between the sexes. A higher proportion of patients who tested negative for HBeAg at baseline had seroclearance (1.33%; 95% CI, 0.76–2.05) than those who tested positive for HBeAg (0.40%; 95% CI, 0.25–0.59) (P < .01). Having HBsAg seroclearance was also associated with a lower baseline HBV DNA level (6.61 log10 IU/mL; 95% CI, 5.94–7.27) vs not having HBsAg seroclearance (7.71 log10 IU/mL; 95% CI, 7.41–8.02) (P < .01) and with a lower level of HBsAg at baseline (2.74 log10 IU/mL; 95% CI, 1.88–3.60) vs not having HBsAg seroclearance (3.90 log10 IU/mL, 95% CI, 3.73–4.06) (P < .01). HBsAg seroclearance was not associated with HBV genotype or treatment history. Heterogeneity was substantial across the studies (I2 = 97.49%).
Conclusion
In a systematic review and meta-analysis, we found a low rate of HBsAg seroclearance in untreated and treated patients (pooled annual rate, approximately 1%). Seroclearance occurred mainly in patients with less active disease. Patients with chronic HBV infection should therefore be counseled on the need for lifelong treatment, and curative therapies are needed.
Keywords:
Natural History, Prognosis, Disease Progression, CHB
Abbreviations used in this paper:
ALT (alanine aminotransferase), cccDNA (covalently closed circular DNA), CHB (chronic hepatitis B), CI (confidence interval), HBeAg (hepatitis B e antigen), HBsAg (hepatitis B surface antigen), HBV (hepatitis B virus), HCC (hepatocellular carcinoma), NOS (Newcastle–Ottawa quality assessment scale)作者: StephenW 时间: 2019-2-7 12:57
与慢性HBV感染成人HBsAg血清清除率相关的因素：系统评价和Meta分析
Yee Hui Yeo
，Hsiu J. Ho
，Hwai-I Yang
，Tai-Chung Tseng
，Tetsuya Hosaka
，Huy N. Trinh
，Min-Sun Kwak
，杨敏公园
，James Yan Yue Fung
，Maria Buti
，ManuelRodríguez
，Sombat Treeprasertsuk
，卡门莫妮卡普雷达
，Teerapat Ungtrakul
，Phunchai Charatcharoenwitthaya
，向永利
，李佳怡
，张健
，Michael Huan Le
，宾威
，毕尧邹
，安乐
，Donghak Jeong
，Nicholas Chien
，Leslie Kam
，李钦钦
，Mar Riveiro-Barciela
，Doina Istratescu
，Tassanee Sriprayoon
，玉田冲
，Tawesak Tanwandee
，Mariko Kobayashi
，Fumitaka Suzuki
，冯凤媛
，Hyo-Suk Lee
，Jia-Horng Kao
，Anna S. Lok
吴春英关于作者吴春英的作者信息，作者吴春英
，Mindie H. Nguyen'关于作者的相关信息Mindie H. Nguyen给作者Mindie H. Nguyen发邮件
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DOI：https：//doi.org/10.1053/j.gastro.2018.10.027 |
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