title: Clinical outcomes of delayed clearance of serum HBsAG in patients with chronic HBV infection.
abstract: BACKGROUND
  Spontaneous delayed clearance of hepatitis B surface antigen (HBsAg) in patients with chronic HBV infection is a rare event. The aim of this study was to investigate the incidence of delayed clearance of serum HBsAg in chronic HBV infection and to determine the characteristics and clinical outcomes of HBsAg delayed clearance in Korean patients.
  
  
  METHODS
  From April 1981 to June 2003, 4,061 patients who were positive for HBsAg were evaluated retrospectively. The following assessments were undertaken in 47 patients who had spontaneous delayed clearance: liver biochemistry, viral markers, alpha-fetoprotein levels, and radiographic examinations including ultrasonography every three to six months for 6-264 months (median 87.9 months).
  
  
  RESULTS
  Twenty-four of 47 patients were asymptomatic carriers. The others included seven patients with chronic hepatitis, seven with liver cirrhosis and nine with hepatocellular carcinoma. The estimated annual incidence of HBsAg seroclearance was 0.4%. The time span from positive HBsAg to HBsAg seroclearance in the AHC, CH, LC, and HCC was 62.9, 141, 63, and 95.3 months during follow up. Twenty-four of 24 AHC remained normal, 5 of 7 CH remained as CH and 2 patients remained normal, 1 of 7 with LC developed HCC and 6 of the LC remained as LC, and 4 of 9 HCC patients died.
  
  
  CONCLUSIONS
  The clinical course following delayed clearance of HBsAg had diverse outcomes from AHC to HCC. Therefore, these patients require close follow up for the possible development of hepatocellular carcinoma following HBsAg clearance.
authors.affiliation: Department of Internal Medicine, The Catholic University of Korea College of Medicine, WHO Collaborating Center for Reference and Research on Viral Hospital, Seoul, Korea.
authors.forename: Soon Woo
authors.initials: SW
authors.lastname: Nam
authors.forename: Jeong Jo
authors.initials: JJ
authors.lastname: Jung
authors.forename: Si Hyun
authors.initials: SH
authors.lastname: Bae
authors.forename: Jong Young
authors.initials: JY
authors.lastname: Choi
authors.forename: Seung Kew
authors.initials: SK
authors.lastname: Yoon
authors.forename: Se Hyun
authors.initials: SH
authors.lastname: Cho
authors.forename: Joon Yeol
authors.initials: JY
authors.lastname: Han
authors.forename: Nam Ik
authors.initials: NI
authors.lastname: Han
authors.forename: Jin Mo
authors.initials: JM
authors.lastname: Yang
authors.forename: Young Suk
authors.initials: YS
authors.lastname: Lee
mesh_terms: D002353:Carrier State; D005260:Female; D006510:Hepatitis B Antibodies / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000097:blood* / Q000276:immunology; D006515:Hepatitis B virus / Q000276:immunology*; D019694:Hepatitis B, Chronic / Q000188:drug therapy / Q000473:pathology / Q000821:virology*; D006801:Humans; D015994:Incidence; D007723:Korea; D008103:Liver Cirrhosis / Q000473:pathology / Q000821:virology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016036:Seroepidemiologic Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens