Acute Hepatitis B Virus Infection in North American Adults

• Published in: Clinical gastroenterology and hepatology Vol. 21; no. 7; pp. 1881 - 1892.e4
• Main Authors: Sterling, Richard K., Wahed, Abdus S., Cloherty, Gavin, Hoofnagle, Jay H., Lee, William M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2023
• Subjects: Adult; Gastroenterology and Hepatology; Hepatitis B; Hepatitis B - drug therapy; Hepatitis B - epidemiology; Hepatitis B e Antigens; Hepatitis B Surface Antigens; Hepatitis B virus - genetics; Hepatitis B, Chronic - drug therapy; Humans; Male; Risk Factors; Seroconversion; United States - epidemiology; United States; AST; HBcrAg; RNA; Risk Factors; CI; HBeAg; HBc; ALT; HBsAg; HR; Seroconversion; HIV; aHBV; DNA; ULN; cHBV; HBRN; HBs; HCV; HDV; HBV; Hepatitis B; ribonucleic acid; hepatitis B virus; hepatitis B core; alanine aminotransferase; hepatitis B e antigen; deoxyribonucleic acid; Hepatitis B Research Network; hepatitis C virus; chronic hepatitis B virus; hepatitis delta virus; hepatitis B surface antigen; hepatitis B core-related antigen; acute hepatitis B virus; aspartate aminotransferase; hepatitis B surface; upper limit of normal; human immunodeficiency virus; hazard ratio; confidence interval
• ISSN: 1542-3565; 1542-7714; 1542-7714
• DOI: 10.1016/j.cgh.2022.09.004

Acute hepatitis B virus (aHBV) is thought to be self-limited with clearance of hepatitis B surface antigen (HBsAg) within 6 months. There are limited reports of the presenting features and outcomes of adults with symptomatic aHBV in the United States. Demographics, clinical features, and 12-month outcomes of patients with adjudicated aHBV were captured prospectively and compared with a contemporaneous cohort of chronic HBV (cHBV) patients enrolled in the Hepatitis B Research Network. Between 2011 and 2018, 60 adjudicated patients with aHBV were compared with 1534 cHBV untreated controls. Although similar in age, other features were dissimilar: aHBV patients were more often male (72% vs 51%), single (72% vs 30%), and non-Hispanic whites or blacks (75% vs 24%). They also were frequently genotype A2 (65% vs 9%), having different risk factors: sexual exposure (75% vs 16%) or injection drug use (10% vs 2%), compared with the cHBV controls. In addition to higher serum aminotransferase and bilirubin levels, acute patients had higher HBV DNA levels (4.8 vs 3.6 log10 IU/mL), whereas quantitative hepatitis B e antigen (HBeAg) levels were lower (1.4 vs 3.0 log10 IU/mL), despite higher rates of HBeAg (73% vs 25%). The median time to HBsAg clearance was 27 weeks and to anti-HBs appearance, 41 weeks. In the current era, caucasian men infected with genotype A2 as a result of sexual exposure or injection drug use were the predominant group in aHBV, suggesting a potential strategy for adult vaccination in North America. Strikingly, only an estimated 36% of subjects cleared HBsAg by month 6; the definition of resolution in acute hepatitis B may need to be modified. ClinicalTirals.gov number NCT01263587.