Serum Hepatitis B Surface Antigen Levels Predict Surface Antigen Loss in Hepatitis B e Antigen Seroconverters

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Gastroenterology

Volume 141, Issue 2 , Pages 517-525.e2, August 2011.

Serum Hepatitis B Surface Antigen Levels Predict Surface Antigen Loss in

Hepatitis B e Antigen Seroconverters

Tai¨CChung Tseng, Chun¨CJen Liu, Tung¨CHung Su, Chia¨CChi Wang, Chi¨CLing Chen,

Pei¨CJer Chen, Ding¨CShinn Chen, Jia¨CHorng Kao

Received 8 November 2010; accepted 11 April 2011. published online 29 April

2011.

Background & Aims

Loss of hepatitis B surface antigen (HBsAg) usually indicates that hepatitis B

virus (HBV) infection has been cured. However, little is known about factors

predicting HBsAg loss in patients who spontaneously clear hepatitis B e antigen

(HBeAg).

Methods

We studied 390 Taiwanese HBeAg-positive patients with chronic hepatitis who had

spontaneously cleared HBeAg (seroconversion) during follow-up. Serum levels of

HBV DNA and HBsAg were determined 1 year after HBeAg seroconversion, and their

relationships with subsequent HBsAg loss were investigated.

Results

In a mean follow-up of 7.4 years, the average annual rate of HBsAg loss was

0.62%. Serum levels of HBsAg and HBV DNA were inversely associated with HBsAg

loss in a dose-response manner. Compared with patients with HBsAg levels ¡Ý1000

IU/mL, the HBsAg loss rate was higher for those with HBsAg levels of 100 to 999

and <100 IU/mL, with hazard ratios of 4.4 (95% confidence interval, 1.1¨C17.0)

and 24.3 (8.7¨C67.5), respectively. Among those who underwent HBsAg loss within

6 years of follow-up, serum HBsAg levels were a better predictor than HBV DNA

levels by receiver operating characteristic curve analysis (area under the

receiver operating characteristic curve, 0.90 vs 0.69; P = .012); an HBsAg level

<100 IU/mL predicted HBsAg loss within 6 years with a diagnostic accuracy of

91.5%, sensitivity of 83.3%, specificity of 92.1%, positive predictive value of

45.5%, and negative predictive value of 98.6% in patients with an HBV DNA level

<200 IU/mL.

Conclusions

Low serum levels of HBsAg, alone or in combination with HBV DNA levels, 1 year

after HBeAg seroconversion can predict HBsAg loss in patients with HBV genotype

B or C infection.