title: Risk factors for long-term persistence of serum hepatitis B surface antigen following acute hepatitis B virus infection in Japanese adults.
abstract: The proportion of patients who progress to chronicity following acute hepatitis B (AHB) varies widely worldwide. Moreover, the association between viral persistence after AHB and hepatitis B virus (HBV) genotypes in adults remains unclear. A nationwide multicenter study was conducted throughout Japan to evaluate the influence of clinical and virological factors on chronic outcomes in patients with AHB. For comparing factors between AHB patients with viral persistence and those with self-limited infection, 212 AHB patients without human immunodeficiency virus (HIV) coinfection were observed in 38 liver centers until serum hepatitis B surface antigen (HBsAg) disappeared or a minimum of 6 months in cases where HBsAg persisted. The time to disappearance of HBsAg was significantly longer for genotype A patients than that of patients infected with non-A genotypes. When chronicity was defined as the persistence of HBsAg positivity for more than 6 or 12 months, the rate of progression to chronicity was higher in patients with genotype A, although many cases caused by genotype A were prolonged cases of AHB, rather than chronic infection. Multivariate logistic regression analysis revealed only genotype A was independently associated with viral persistence following AHB. A higher peak level of HBV DNA and a lower peak of alanine aminotransferase (ALT) levels were characteristics of AHB caused by genotype A. Treatment with nucleotide analogs (NAs) did not prevent progression to chronic infection following AHB overall. Subanalysis suggested early NA initiation may enhance the viral clearance.
  
  
  CONCLUSIONS
  Genotype A was an independent risk factor for progression to chronic infection following AHB. Our data will be useful in elucidating the association between viral persistence after AHB, host genetic factors, and treatment with NAs in future studies.
authors.affiliation: The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, Ichikawa, Japan; Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan.
authors.forename: Kiyoaki
authors.initials: K
authors.lastname: Ito
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yotsuyanagi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yatsuhashi
authors.forename: Yoshiyasu
authors.initials: Y
authors.lastname: Karino
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Takikawa
authors.forename: Takafumi
authors.initials: T
authors.lastname: Saito
authors.forename: Yasuji
authors.initials: Y
authors.lastname: Arase
authors.forename: Fumio
authors.initials: F
authors.lastname: Imazeki
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kurosaki
authors.forename: Takeji
authors.initials: T
authors.lastname: Umemura
authors.forename: Takafumi
authors.initials: T
authors.lastname: Ichida
authors.forename: Hidenori
authors.initials: H
authors.lastname: Toyoda
authors.forename: Masashi
authors.initials: M
authors.lastname: Yoneda
authors.forename: Eiji
authors.initials: E
authors.lastname: Mita
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Kojiro
authors.initials: K
authors.lastname: Michitaka
authors.forename: Tatsuji
authors.initials: T
authors.lastname: Maeshiro
authors.forename: Junko
authors.initials: J
authors.lastname: Tanuma
authors.forename: Yasuhito
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Masaya
authors.initials: M
authors.lastname: Sugiyama
authors.forename: Kazumoto
authors.initials: K
authors.lastname: Murata
authors.forename: Naohiko
authors.initials: N
authors.lastname: Masaki
authors.forename: Masashi
authors.initials: M
authors.lastname: Mizokami
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005838:Genotype; D006147:Guanine / Q000031:analogs & derivatives / Q000627:therapeutic use; D006509:Hepatitis B / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology* / Q000821:virology; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D006515:Hepatitis B virus / Q000235:genetics; D006801:Humans; D007564:Japan / Q000453:epidemiology; D019259:Lamivudine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D006514:Hepatitis B Surface Antigens; D019259:Lamivudine; C413685:entecavir; D006147:Guanine