title: Delayed clearance of serum HBsAg in compensated cirrhosis B: relation to interferon alpha therapy and disease prognosis. European Concerted Action on Viral Hepatitis (EUROHEP)
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Istituto di Patologia Speciale Medica, Cattedra di Medicina Interna, University of Verona, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Fattovich
authors.forename: G
authors.initials: G
authors.lastname: Giustina
authors.forename: J
authors.initials: J
authors.lastname: Sanchez-Tapias
authors.forename: C
authors.initials: C
authors.lastname: Quero
authors.forename: A
authors.initials: A
authors.lastname: Mas
authors.forename: P G
authors.initials: PG
authors.lastname: Olivotto
authors.forename: A
authors.initials: A
authors.lastname: Solinas
authors.forename: P
authors.initials: P
authors.lastname: Almasio
authors.forename: S
authors.initials: S
authors.lastname: Hadziyannis
authors.forename: F
authors.initials: F
authors.lastname: Degos
authors.forename: M C
authors.initials: MC
authors.lastname: de Moura
authors.forename: K
authors.initials: K
authors.lastname: Krogsgaard
authors.forename: M
authors.initials: M
authors.lastname: Pantalena
authors.forename: G
authors.initials: G
authors.lastname: Realdi
authors.forename: R
authors.initials: R
authors.lastname: Corrocher
authors.forename: S W
authors.initials: SW
authors.lastname: Schalm
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000209:etiology; D015331:Cohort Studies; D018450:Disease Progression; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy / Q000821:virology; D008113:Liver Neoplasms / Q000209:etiology; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D006514:Hepatitis B Surface Antigens; D016898:Interferon-alpha