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Chronic hepatitis B virus (HBV) infection is a major health problem worldwide, with complications such as cirrhosis, liver failure and hepatocellular carcinoma (HCC) leading to a severe disease burden, mortality and morbidity
.
A negative serotest for HBsAg is defined as a functional "cure" marker for HBV infection
.
However, spontaneous HBsAg seroclearance is rare with or without treatment, with an estimated annual clearance of 1.
02%.
HBsAg seroclearance has important benefits in patients with chronic HBV, including reduced risk
of developing liver cancer.
Several studies have elucidated potential predictors
of spontaneous HBsAg seroclearance.
Most notably, less active hepatitis B is often associated with
increased seroclearance of HBsAg in treated and untreated patients.
Specifically, patients with low baseline HBV DNA levels and HBsAg levels had higher serum clearance than controls
.
However, despite the extensive understanding of predictors of HBsAg seroclearance, there are few
studies on the effect of serum clearance of HBsAg in the liver parenchyma in patients with chronic HBV.
Liver transient elastography is a non-invasive imaging method that estimates liver stiffness
by the speed of elastic shear waves transducted by the liver parenchyma.
The use of transient elastography of the liver in patients with chronic hepatitis B can be used as a reliable clinical predictor of severe liver fibrosis and subsequent clinical prognosis in patients with chronic hepatitis B infection
.
Transient elastography (TE) is a reliable method
for assessing liver fibrosis in patients with liver disease.
This study aimed to assess the potential clinical association
between HBsAg serological clearance and the severity of liver fibrosis.
To this end, the researchers retrospectively matched 23 patients with continuous HBsAg seroclearance who underwent TE in community practice between March 2008 and August 2021 in a ratio of 1:3, based on the date of
clinic visit.
Collect baseline laboratory and clinical data
.
The Fisher exact test and chi-square test were performed on the proportions, and the relevant statistical analysis
of the Wilcoxon rank sum test was performed on the median.
The results of the study showed that the retrospective analysis identified 23 cases and 69 control patients
.
The median follow-up time (interquartile range) for the case and control groups was 24,314 (1402) days and 2332 (1587) days, respectively (p=0.
15).
All patients are Asian
.
The median age of the case group was higher than that of the control group (64 vs 52, p < 0.
01).
Although most comorbidities are similar, diabetes and hyperlipidemia are more prevalent
in the case group.
Baseline HBV DNA (p < 0.
01)
was detectable in 78% of patients in the case group and 97% of patients in the control group.
More patients (81% vs 8.
7%, p <0.
01)
had a baseline HBsAg titer of less than 1000 IU/mL compared with controls.
Other baseline laboratory values were similar
.
Few cases had fibrosis scores greater than 1, while more than a quarter of patients in the control group had fibrosis scores of 2 or 3
.
This study confirms that spontaneous HBsAg serological clearance is still rare in patients with chronic HBV infection, but it is associated with
low baseline HBsAg and lower levels of liver fibrosis detected by TE.
Original source:
Sammy Saab.
et al.
Spontaneous Seroclearance Is Associated with Lower Liver Fibrosis in Treatment-Naïve Chronic Hepatitis B Patients.
Digestive Diseases and Sciences.
2022.