Determinants of spontaneous surface antigen loss in HBeAg-negative patients with a low viral load

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http://onlinelibrary.wiley.com/doi/10.1002/hep.24615/abstract

Viral Hepatitis

Determinants of spontaneous surface antigen loss in HBeAg-negative patients with

a low viral load

Tai-Chung Tseng1,3,7, Chun-Jen Liu2,3, Hung-Chih Yang2,6, Tung-Hung Su2,3,

Chia-Chi Wang1,7, Chi-Ling Chen3, Fang-Tzu Kuo8, Chen-Hua Liu2,3,

Pei-Jer Chen2,3, Ding-Shinn Chen2,3, Jia-Horng Kao2,3,4,5,*,†DOI:

10.1002/hep.24615

Copyright © 2011 American Association for the Study of Liver Diseases

Issue

Hepatology

Accepted Article (Accepted, unedited articles published online for future

issues)

Abstract

Background & Aims:

Loss of hepatitis B surface antigen (HBsAg) usually indicates the cure of

hepatitis B virus (HBV) infection. In spontaneous hepatitis B e antigen (HBeAg)

seroconverters, lower serum HBsAg and HBV DNA levels have been shown to be

associated with HBsAg loss over time. However, little is known about their

impacts on HBsAg loss in HBeAg-negative patients with limited viral replication.

Methods:

A total of 688 HBeAg-negative patients with baseline serum HBV DNA levels <2000

IU/mL were enrolled in Taiwan. The relationships of HBsAg and HBV DNA levels

with subsequent HBsAg loss were investigated.

Results:

In a mean follow-up of 11.6 years, the average annual rate of HBsAg loss was

1.6%. Baseline HBsAg and HBV DNA levels were inversely associated with

subsequent HBsAg loss. When compared to patients with HBsAg levels >1000 IU/mL,

the rates of HBsAg loss were significantly higher in patients with HBsAg levels

of 100-999, 10–99 <10 IU/mL, with hazard ratios of 2.5 [95% confidence

interval (CI), 1.6–4.0], 2.8 (95% CI, 1.6-5.0), and 13.2 (95% CI, 8.1–21.5),

respectively. Multivariate analysis showed that HBsAg level, but not HBV DNA,

remained as an independent factor. The adjusted hazard ratio of HBsAg loss was

13.2 (95% CI, 7.8-22.1) for HBsAg level<10 versus ≧1000 IU/mL. When compared

to HBV DNA level by receiver operating characteristic curve analysis, HBsAg

level served as a better predictor of both 5-year and 10-year HBsAg loss.

Conclusions:

In HBeAg-negative patients with HBV genotype B or C infection who have HBV DNA

<2000 IU/mL, HBsAg <10 IU/mL is the strongest predictor of HBsAg loss.

(HEPATOLOGY 2011.)