title: Spontaneous clearance of high-titer serum HBV DNA and risk of hepatocellular carcinoma in a Chinese population.
abstract: Chronic hepatitis B virus (HBV) carriers with high-titer viremia (>10(5) virions/ml) are at increased risk for hepatocellular carcinoma (HCC). The aim of this study was to determine the relationship between clearance of high-titer viremia and subsequent risk of HCC. The study population was a prospective cohort of 114 adults from Haimen City, China, all HBV DNA(+) at study entry and followed for 797.8 person-years in total. During follow-up, 54 (47.4%) subjects spontaneously cleared high-titer viremia at least once. Of these, 27 were considered to have undergone stable seroconversion, 16 were considered unstable (12 reversions to HBV DNA positivity and 4 multiple clearances), and 11 did not have sufficient follow-up to determine stability. Of the 114 persons, 26 (22.8%) died during follow-up, 21 (18.4%) from HCC. Using Cox proportional hazards models, the RR of HCC death associated with seroconversion was 2.8 (95% CI = 1.1-7.4), controlling for age, sex, family HCC history, history of acute hepatitis, alcohol use and cigarette smoking. In conclusion, fluctuations of high-titer viremia may indicate increased hepatocellular damage and at least short-term increases in HCC risk. Long-term longitudinal studies are needed to clarify this relationship and its potential usefulness as a prognostic marker in chronic HBV infection.
authors.affiliation: Division of Population Science, Fox Chase Cancer Center, Philadelphia, PA 19111, USA.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Harris
authors.forename: Gang
authors.initials: G
authors.lastname: Chen
authors.forename: Wen Yao
authors.initials: WY
authors.lastname: Lin
authors.forename: Fu Min
authors.initials: FM
authors.lastname: Shen
authors.forename: W Thomas
authors.initials: WT
authors.lastname: London
authors.forename: Alison A
authors.initials: AA
authors.lastname: Evans
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000821:virology*; D002353:Carrier State / Q000821:virology*; D016022:Case-Control Studies; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D004279:DNA, Viral / Q000032:analysis; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006515:Hepatitis B virus / Q000235:genetics / Q000302:isolation & purification*; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D008113:Liver Neoplasms / Q000453:epidemiology / Q000821:virology*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D016016:Proportional Hazards Models; D019914:Taq Polymerase; D019562:Viral Load; D014766:Viremia / Q000150:complications / Q000821:virology
chemical_list: D004279:DNA, Viral; D019914:Taq Polymerase