慢性感染患者乙型肝炎血清阳性率

StephenW

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.

StephenW

慢性感染患者乙型肝炎血清阳性率

Atif Zaman，MD，MPH审查Yeo YH等人。消化内科2018年10月17日

无论接受治疗，HBV清除率都很低，乙型肝炎e抗原血清阳性率进一步降低。

目前的乙型肝炎病毒（HBV）疗法对病毒抑制有效，但对病毒清除无效。报告的自发和治疗诱导的病毒清除率在当前文献中有所不同。该系统评价和荟萃分析试图进行更精确的估计。

审查人员搜索数据库，以确定报告HBV感染患者乙型肝炎表面抗原（HBsAg）血清清除率的研究，这些患者随访至少1年，并且在随访期间至少进行了一次HBsAg检测。使用随机效应模型在5年，10年和15年确定累积的HBsAg血清清除率。

荟萃分析纳入34篇文章，其中包括42,588名患者; 34项研究中有22项被认为存在低偏倚风险。在超过300,000人年的随访期间，共有3194名患者出现HBsAg血清清除。汇总年率为1％，5年，10年和15年的比率分别为4％，8％和18％。无论HBV基因型状态，接受HBV治疗或肝硬化状态如何，血清清除率相似。然而，乙型肝炎e抗原（HBeAg）阴性患者的血清清除率比HBeAg阳性患者高3倍（1.3％对0.4％）。
评论

虽然这些研究存在显着的异质性，但这项综合的荟萃分析（包括最近的数据）能够准确估计血清清除率。它清楚地表明HBsAg血清清除是否罕见，无论患者是否接受HBV治疗，这意味着患者将这样的研究强调了未来研究的重要性，以确定治疗慢性HBV感染的新型治疗药物。在此之前，临床医生应继续告知患者HBV治疗是终生的。
读者注意：在我们审阅本文时，其出版商指出它不是最终形式，可能会随后需要。

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