Delayed clearance of serum HBsAg in compensated cirrhosis B: relation to interferon alpha therapy and disease prognosis. European Concerted Action on Viral Hepatitis (EUROHEP)

• Published in: The American journal of gastroenterology Vol. 93; no. 6; pp. 896 - 900
• Main Authors: Fattovich, G, Giustina, G, Sanchez-Tapias, J, Quero, C, Mas, A, Olivotto, P G, Solinas, A, Almasio, P, Hadziyannis, S, Degos, F, de Moura, M C, Krogsgaard, K, Pantalena, M, Realdi, G, Corrocher, R, Schalm, S W
• Format: Journal Article
• Language: English
• Published: United States 01.06.1998
• Subjects: Adult; Carcinoma, Hepatocellular - etiology; Cohort Studies; Disease Progression; Follow-Up Studies; Hepatitis B - complications; Hepatitis B - diagnosis; Hepatitis B - mortality; Hepatitis B - therapy; Hepatitis B Surface Antigens - blood; Humans; Interferon-alpha - therapeutic use; Liver Cirrhosis - diagnosis; Liver Cirrhosis - mortality; Liver Cirrhosis - therapy; Liver Cirrhosis - virology; Liver Neoplasms - etiology; Prognosis; Regression Analysis; Retrospective Studies; Treatment Outcome
• ISSN: 0002-9270

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. This was a retrospective cohort study of 309 consecutive white patients with biopsy-proved compensated cirrhosis type B. 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. 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.