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Long‐term outcome of inactive and active, low viraemic HB eAg‐negative‐hepatitis B virus infection: Benign course towards HB sAg clearance
Author(s) -
Oliveri Filippo,
Surace Lidia,
Cavallone Daniela,
Colombatto Piero,
Ricco Gabriele,
Salvati Nicola,
Coco Barbara,
Romagnoli Veronica,
Gattai Riccardo,
Salvati Antonio,
Moriconi Francesco,
Yuan Quan,
Bonino Ferruccio,
Brunetto Maurizia R.
Publication year - 2017
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.13416
Subject(s) - medicine , gastroenterology , hepatitis b virus , hepatocellular carcinoma , clearance , virology , immunology , virus , urology
Background & Aims The difference between the long‐term outcome of low‐viraemic ( HBV ‐ DNA ≤20 000‐ IU / mL , LV ‐ AC ) and inactive HB sAg carriers ( HBV ‐ DNA ≤2000‐ IU / mL , IC ) remains to be defined. We studied prospectively 153 HB eAg‐negative HB sAg‐carriers with baseline HBV ‐ DNA ≤20 000‐ IU / mL and normal transaminases. Methods IC , LV ‐ AC or chronic hepatitis B ( CHB ) ( HBV ‐ DNA persistently ≤2000‐ IU / mL , ≤20 000‐ IU / mL or >20 000‐ IU / mL respectively) were diagnosed after 1‐year, 3‐monthly monitoring. Thereafter IC and LV ‐ AC were followed‐up for additional 57.2 (8.5‐158.3) months. HBV ‐ DNA , HB sAg, HBV ”core‐related”Antigen ( HB crAg) and total‐anti‐ HB c were quantified at baseline. Results After the 1st year diagnostic follow‐up CHB [higher HBV ‐ DNA ( P =.005), total‐anti‐ HB c ( P =.012), ALT ( P =.007) and liver‐stiffness ( P =.021)] was identified in 20 (13.1%) carriers; baseline HB sAg≤1000 IU / HBV ‐ DNA ≤2000 IU / mL excluded the presence of CHB ( NPV ‐100%). Thereafter, during the long‐term follow‐up none of 87 IC reactivated, 19 (21.8%) cleared HB sAg [older‐age ( P =.004), lower HB sAg ( P <.001), higher yearly HB sAg decline ( P <.001)]. Twenty‐five of 46 (54.3%) LV ‐ AC remained stable, 20 (43.5%) became IC and 1 (2.2%) developed CHB . The best single‐point CHB and IC diagnostic‐accuracies were total‐anti‐ HB c (84.2%, NPV ‐98.2%) and HBV ‐ DNA /total‐anti‐ HB c/ HB crAg combination (89.5%, 93%‐sensitivity, 84.8%‐specificity) respectively. Conclusions Viraemia persistently ≤20 000‐ IU / mL predicts a benign clinical outcome: it was associated with transition to IC in 43% of LV ‐ AC and to Occult HBV Infection in 20% of IC within 5‐years. Nevertheless, 13.1% of individuals with low viraemia at presentation develops CHB within 1 year: 1‐year HBV ‐ DNA monitoring resulted the most accurate diagnostic approach that can be limited to at least a half of cases by the single point HBV ‐ DNA / HB sAg quantification. The IC ‐diagnostic‐accuracy combining HBV ‐ DNA /total‐anti‐ HB c/ HB crAg needs to be confirmed in further studies.