HBsAg SEROCLEARANCE

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HBsAg SEROCLEARANCE Outcomes in Chinese patients. HBsAg seroclearance rarely occurs in Chinese patients who acquire chronic HBV infection early in life. Man-Fung Yuen et al reviewed medical records of 3,843 patients with chronic hepatitis B who had been followed regularly at the University of Hong Kong Queen Mary Hospital between August 1975 and October 2001 and identified 92 patients who had HBsAg seroclearance. Patients were compared with 92 HBsAg-positive controls matched for age, sex, and duration of follow-up. The mean age of patients with HBsAg seroclearance was 48.8 years, and the median duration of follow-up after seroclearance was 51 months (range, 18.7-199.6 mo). Ninety-eight percent of patients (n=91) had undetectable levels of serum HBV DNA (Cobas Amplicor, LLD = 200 copies/mL) after HBsAg seroclearance. Among 66 evaluable patients, none had detectable HBV DNA in peripheral blood mononuclear cells after HBsAg seroclearance. Of the 14 patients with assessable liver biopsies following HBsAg seroclearance, 12 patients (85.7%) had nearly normal liver histology. Among 16 evaluable patients with HBsAg seroclearance, intrahepatic HBV DNA was undetectable (Invader assay) in 10 patients. For the 6 HBsAg-seroclearance patients with detectable intrahepatic DNA, the median percentage of cccDNA was 100% (range, 71.3-100%) compared with 5.8% (range, 2.6-58%) for 13 evaluable control patients (P <0.0001). No difference in the risk for the development of hepatocellular carcinoma (HCC) between HBsAg-seroclearance patients (n=5) and controls (n=7) was observed. Four of the 5 HBsAg-seroclearance patients with HCC had evidence of cirrhosis. These findings demonstrated that HBsAg seroclearance in Chinese patients is associated with favorable biochemical, virological, and histological changes; however, the risk for HCC is not altered. These results compare with those of a previous study conducted by Yi-Cheng Chen et al in Taipei, Taiwan. In this analysis, 218 chronic HBV patients who had undergone spontaneous HBsAg seroclearance were followed for a median of 61.7 months (range, 12-179 mo). Of 189 noncirrhotic patients in this population, only 3 (1.6%) progressed to cirrhosis and 2 (1.1%) developed HCC; all complications occurred in patients co-infected with HCV or hepatitis delta virus. Among the 29 cirrhotic patients, 4 (13.8%) had hepatic decompensation and 1 (3.4%) died of HCC. This study showed that among patients who did not have cirrhosis and who were not co-infected with HCV or hepatitis delta virus, the prognosis is excellent following spontaneous HBsAg seroclearance. (Yuen M-F et al. Hepatology 2004;39:1694-1701. Chen Y-C et al. Gastroenterology 2002;123:1084-1089.)