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Coexistence of hepatitis B surface antigen and antibody to hepatitis B surface may increase the risk of hepatocellular carcinoma in chronic hepatitis B virus infection: A retrospective cohort study
Author(s) -
Seo Seung In,
Choi Hyeok Soo,
Choi Bo Youn,
Kim Hyoung Su,
Kim Hak Yang,
Jang Myoung Kuk
Publication year - 2014
Publication title -
journal of medical virology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.782
H-Index - 121
eISSN - 1096-9071
pISSN - 0146-6615
DOI - 10.1002/jmv.23779
Subject(s) - medicine , hbsag , hepatocellular carcinoma , hepatitis b virus , gastroenterology , hazard ratio , hepatitis b , risk factor , cirrhosis , univariate analysis , cohort , cumulative incidence , multivariate analysis , confidence interval , immunology , virus
The simultaneous detection of hepatitis B surface antigen (HBsAg) and antibody to hepatitis B surface (anti‐HBs) is unusual in chronic hepatitis B virus (HBV) infection, but may be related with more advanced liver diseases. This retrospective long‐term cohort study was aimed to investigate whether coexistence of HBsAg and anti‐HBs may increase the risk of hepatocellular carcinoma (HCC) in chronic HBV infection. A total of 1,042 non‐HCC patients were recruited and followed up for a median 4.3 years (range 1.0–22 years). Univariate and multivariate analyses were performed to identify the risk factors for HCC development. The prevalence of coexistence of HBsAg and anti‐HBs was 7.0% (73/1,042). In univariate analysis, the 5‐, 10‐, and 15‐year cumulative incidences of HCC were significantly higher in coexistence group than in HBsAg only group (12.7%, 23.4%, 69.4% vs. 4.9%, 13%, 20.6%, respectively; P = 0.008). In multivariate analysis, coexistence of HBsAg and anti‐HBs [Hazard ratio (HR), 2.001; 95% confidence interval (CI), 1.023–3.912; P = 0.043] as well as male gender [HR, 1.898; 95% CI, 0.31–0.896; P = 0.018], age over 40 years [HR, 14.56; 95% CI, 4.499–47.08; P = 0.0001], and cirrhosis [HR, 7.995; 95% CI, 4.756–13.439; P = 0.0001] was identified as the independent factor for HCC development. Also, the cumulative incidence of HCC increased in proportion to the number of the risk factors. In conclusion, coexistence of HBsAg and anti‐HBs may increase independently the risk of HCC development in chronic HBV infection. Therefore, consideration of HCC development is required in patients with coexistence of HBsAg and anti‐HBs. J. Med. Virol. 86:124–130, 2014 . © 2013 Wiley Periodicals, Inc.