Delayed clearance of serum HBsAg in compensated cirrhosis B: relation to interferon alpha therapy and disease prognosis

• Published in: The American journal of gastroenterology Vol. 93; no. 6; pp. 896 - 900
• Main Authors: FATTOVICH, G, GIUSTINA, G, CARNEIRO DE MOURA, M, KROGSGAARD, K, PANTALENA, M, REALDI, G, CORROCHER, R, SCHALM, S. W, SANCHEZ-TAPIAS, J, QUERO, C, MAS, A, OLIVOTTO, P. G, SOLINAS, A, ALMASIO, P, HADZIYANNIS, S, DEGOS, F
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Publishing 01.06.1998
• Subjects: Biological and medical sciences; Gastroenterology. Liver. Pancreas. Abdomen; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Medical sciences; Other diseases. Semiology; Prognosis; Liver; Orthohepadnavirus; Hepatic disease; Clearance; Delay; Viral hepatitis B; Immunology; Hepadnaviridae; Immunotherapy; Complication; Evolution; Biological effect; Hepatitis B virus; Human; Hepatitis B surface antigen; Statistical study; Infection; Virus; Cirrhosis; Chronic; Viral disease; Digestive diseases; Interferon; Predictive factor
• ISSN: 0002-9270; 1572-0241
• DOI: 10.1111/j.1572-0241.1998.00272.x

Objective:The aim of this study was to evaluate the incidence, prognostic factors and clinical significance of delayed clearance of serum HBsAg in compensated cirrhosis B. Methods:This was a retrospective cohort study of 309 consecutive white patients with biopsy-proved compensated cirrhosis type B. Results:During a mean follow-up of 68 months, HBsAg loss occurred in 32 patients, including 16 (8%) of 196 untreated patients (mean annual incidence 0.8%), 8 (10%) of 82 interferon (IFN) alpha-treated patients and eight patients who had been treated with other antivirals or steroids. The 5-yr probability of HBsAg loss was 4% and 16% for untreated and IFN-treated patients, respectively (p= 0.0001). Cox's regression analysis identified hepatitis B e antigen-positivity at entry as the sole independent prognostic factor for HBsAg loss. Of the 32 patients who lost HBsAg, one (3%) subsequently developed hepatocellular carcinoma (HCC) and died, whereas, among the patients who remained HBsAg-positive, 11% developed HCC and 20% had died. The probability of HCC appearance was lower (p= 0.0137) and survival was longer (p= 0.0006) in patients who cleared HBsAg compared with patients with HBsAg persistence. Conclusion:The incidence of HBsAg loss is about 0.8% in cirrhosis type B. Prognostic factors for clearance of HBsAg are initial HBeAg positivity and therapy with alpha interferon. Patients with cirrhosis type B, who lose HBsAg, have a low risk for liver cancer or liver-related death.American Journal of Gastroenterology (1998) 93, 896-900; doi:10.1111/j.1572-0241.1998.00272.x