title: Factors associated with spontaneous HBsAg clearance in chronic hepatitis B patients followed at a university hospital.
abstract: BACKGROUND
  Few studies have evaluated the factors involved in the spontaneous HBsAg seroclearance in patients with chronic hepatitis B (HBV) followed up on a long-term basis from areas with a low prevalence of HBV infection. We aimed to determine the rate of spontaneous HBsAg seroclearance and the factors related to it in patients with chronic HBV infection followed up at the Hepatitis Outpatient Clinic of HCFMRP from 1992-2008.
  
  
  METHODS
  A total of 548 patients with chronic HBV infection (366 with chronic hepatitis B and 182 inactive carriers) were followed for 15 years and 9 months with an annual measurement of HBV-DNA, ALT, AST and GGT (average of 4 annual determinations) and serology (HBsAg, HBeAg, Anti-HBeAg and Anti-HBsAg).
  
  
  RESULTS
  Spontaneous HBsAg seroclearance occurred in 40 patients (7.3%) with a mean age of 46.0 ± 14.4 years, corresponding to an annual rate of 0.7%.The factors related to spontaneous HBsAg seroclearance were inactive carrier status (67.5 vs. 32.5%, p = 0.000191) and age of more than 40 years (p = 0.0007). There was no difference in the rate of spontaneous HBsAg seroclearance when comparing males and females (p = 0.383). Patients with spontaneous HBsAg seroclearance did not progress to more severe forms of the disease during follow-up.
  
  
  CONCLUSIONS
  Spontaneous HBsAg seroclearance has a favorable long-term prognosis in patients with chronic HBV infection. HBsAg seroclearance occurred at rates compatible with low prevalence areas and was associated with low serum HBV-DNA levels and an age older than 40 years.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine.
authors.forename: Sandro C
authors.initials: SC
authors.lastname: Ferreira
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine.
authors.forename: Silvana G F
authors.initials: SG
authors.lastname: Chachá
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine.
authors.forename: Fernanda F
authors.initials: FF
authors.lastname: Souza
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine.
authors.forename: Andreza C
authors.initials: AC
authors.lastname: Teixeira
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine.
authors.forename: Rodrigo C
authors.initials: RC
authors.lastname: Santana
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine.
authors.forename: Márcia G
authors.initials: MG
authors.lastname: Villanova
authors.affiliation: Department of Pathology, Faculty of Medicine of Ribeirão Preto, University of São Paulo - FMRP-USP, Ribeirão Preto, Brazil; Inmemorian.
authors.forename: Sérgio
authors.initials: S
authors.lastname: Zucoloto
authors.affiliation: Department of Pathology, Faculty of Medicine of Ribeirão Preto, University of São Paulo - FMRP-USP, Ribeirão Preto, Brazil.
authors.forename: Leandra N
authors.initials: LN
authors.lastname: Ramalho
authors.affiliation: Department of Social Medicine, Faculty of Medicine of Ribeirão Preto, University of São Paulo - FMRP-USP, Ribeirão Preto, Brazil.
authors.forename: Gleici S C
authors.initials: GS
authors.lastname: Perdoná
authors.affiliation: Department of Social Medicine, Faculty of Medicine of Ribeirão Preto, University of São Paulo - FMRP-USP, Ribeirão Preto, Brazil.
authors.forename: Afonso D C
authors.initials: AD
authors.lastname: Passos
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine.
authors.forename: Ana L C
authors.initials: AL
authors.lastname: Martinelli
mesh_terms: D000328:Adult; D000367:Age Factors; D002353:Carrier State; D004279:DNA, Viral / Q000097:blood*; D018450:Disease Progression; D005260:Female; D006510:Hepatitis B Antibodies / Q000276:immunology*; D006514:Hepatitis B Surface Antigens / Q000097:blood / Q000276:immunology; D006513:Hepatitis B e Antigens / Q000097:blood / Q000276:immunology*; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology; D019694:Hepatitis B, Chronic / Q000097:blood / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012737:Sex Factors; D055815:Young Adult
chemical_list: D004279:DNA, Viral; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D006513:Hepatitis B e Antigens