HIV and Hepatitis.com Coverage of
Digestive Disease Week 2007
May 19 - 24, 2007, Washington DC

Prognosis Following Hepatitis B Surface Antigen Clearance

Seroclearance of hepatitis B surface antigen (HBsAg) remains the goal of antiviral therapy for chronic hepatitis B, but some research suggest that patients who clear HBsAg remain at risk for hepatic complications including liver cirrhosis and hepatocellular carcinoma (HCC).

As reported at the Digestive Disease Week 2007 meeting last month in Washington, DC, researchers from Tufts-New England Medical Center in Boston conducted a literature review to quantify prognosis following HBsAg clearance and to identify risk factors for liver disease progression.

In a systematic review of MEDLINE, Web of Science, and various bibliographies, the investigators identified 9 retrospective cohort studies comprising a total of 1398 patients that reported on clinical course after HBsAg seroclearance; 7 of these involved Asian subjects). They extracted data regarding development of HCC, hepatic decompensation (ascites or varices), and liver-related death. In 4 studies with controls, they compared outcomes in patients with and without HBsAg seroclearance.

To identify risk factors for progression among patients with HBsAg seroclearance, they compared outcomes in individuals with and without cirrhosis, as well as HBV monoinfected patients versus those with HIV, hepatitis C, or hepatitis delta coinfection.

Results

  • Overall, the mean age was 46 years; 80% of subjects were men, and 31% had evidence of cirrhosis.

  • The mean duration of follow-up was 47 months (range 19-78).

  • At the end of follow-up, HBV was detectable in the serum of 32 out of 395 patients (8%) and in liver biopsies of 50 out of 62 patients (81%).

  • When comparing patients with and without HBsAg seroclearance, the odds ratios were:

    • 0.6 for any liver complication;
    • 0.6 for HCC;
    • 1.1 for hepatic decompensation;
    • 0.3 for liver-related mortality.

  • The risk of complications in patients with HBsAg seroclearance was higher in those with cirrhosis and in coinfected patients.

  • Compared to patients without cirrhosis, those with cirrhosis had an odds ratio of 17.0 for developing HCC, 16.8 for liver failure, and 4.8 for liver-related death.

  • For patients with any coinfection versus those with HBV monoinfection, the odds ratios were 10.9 for any hepatic complication in patients with cirrhosis and 4.5 in those without cirrhosis.

  • For hepatitis C coinfection, the odds ratio for developing any hepatic complication was 17.4.

Conclusion

“Patients with HBsAg seroclearance had lower risks of developing complications, but none of these results were statistically significant,” the investigators concluded. “In those with HBsAg seroclearance, the presence of cirrhosis or coinfection was associated with a statistically significant increase in HCC or hepatic complications respectively.”

06/01/07

Reference
AK Retana, A Rajendra, JB Wong, and others. Prognosis following hepatitis B surface antigen seroclearance: a systematic review of 9 cohort studies and 1398 patients. Digestive Disease Week 2007. Washington, DC. May 19-24, 2007. Abstract 91.

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