title: Long-term outcome in Caucasian patients with chronic hepatitis B virus infection after HBsAg seroclearance.
abstract: OBJECTIVE
  The natural course after hepatitis B surface antigen (HBsAg) seroclearance in Caucasian patients with chronic hepatitis B virus (HBV) infection is not well-defined. To investigate the clinical characteristics and outcome in a series of European Caucasian patients with chronic HBV infection according to HBsAg response over time.
  
  
  METHODS
  A total of 612 patients with compensated chronic HBV infection and without other cause of liver disease were prospectively followed up. Seventy-eight subjects cleared HBsAg and 534 remained HBsAg-positive. Clinical and virological examinations were periodically performed and development of cirrhosis and liver-related complications was monitored during a mean follow-up time of 9.9 years.
  
  
  RESULTS
  After HBsAg seroclearance, serum HBV DNA was undetectable in 38 patients in whom it was tested and HBsAg reappearance was observed in two subjects (2.6%). At 15 years of follow-up, the cumulative probability of developing a liver-related complication was 11.6% in HBsAg-positive patients and 1.8% in those with HBsAg loss (P = 0.03), although this benefit was limited to patients with cirrhosis (P < 0.001) and to those who received therapy (P < 0.01). Among patients without cirrhosis and among those who did not receive therapy, the probability was not different between those who cleared the HBsAg and those who did not (P = 0.3 and P = 0.5 respectively).
  
  
  CONCLUSIONS
  Hepatitis B surface antigen loss confers a significant clinical benefit in Caucasian subjects with HBV-related cirrhosis and in those with chronic HBV infection who receive antiviral therapy. However, HBsAg reappearance can be observed in selected cases.
authors.affiliation: Liver Unit, Division of Gastroenterology and Hepatology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Lauret
authors.forename: María L
authors.initials: ML
authors.lastname: González-Diéguez
authors.forename: Mercedes
authors.initials: M
authors.lastname: Rodríguez
authors.forename: Marta
authors.initials: M
authors.lastname: González
authors.forename: Santiago
authors.initials: S
authors.lastname: Melón
authors.forename: Luis
authors.initials: L
authors.lastname: Rodrigo
authors.forename: Manuel
authors.initials: M
authors.lastname: Rodríguez
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D004279:DNA, Viral / Q000097:blood; D005500:Follow-Up Studies; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D019694:Hepatitis B, Chronic / Q000097:blood / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology*; D006652:Histological Techniques; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000097:blood / Q000209:etiology*; D011379:Prognosis; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D044465:White People
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens
keywords: antiviral therapy; chronic hepatitis B complications; cirrhosis; hepatitis B reactivation; hepatitis B resolved infection; hepatocellular carcinoma