title: Ethnic differences in incidence of hepatitis B surface antigen seroclearance in a real-life multicenter clinical cohort of 4737 patients with chronic hepatitis B infection.
abstract: Hepatitis B surface antigen (HBsAg) positivity is associated with increased risk for cirrhosis and hepatocellular carcinoma (HCC). HBsAg seroclearance is thought to be rare in general, but cohort data from US patients are limited.
  
  
  
  To determine the incidence of HBsAg seroclearance in a real-life US cohort.
  
  
  
  In total, 4737 patients with chronic hepatitis B from five primary care, gastroenterology and multispecialty centres, and a university medical centre were retrospectively enrolled between 2001 and 2014 with data obtained by manual review of individual patient medical records. Seroclearance was determined by loss of HBsAg seropositivity. Persistent HBsAg was confirmed by direct serology or by proxy with positive hepatitis B e-antigen (HBeAg) or HBV DNA levels.
  
  
  
  HBsAg seroclearance occurred in 52 patients over 16 844 person-years (0.31% annually, 1.2% overall). Median follow-up was 32 months, and mean age 45 ± 14 years. Incidence of HBsAg seroclearance was higher in non-Asians, age >45, males, and those with baseline HBV DNA ≤10 000 IU/mL. On multivariate Cox proportional modelling, non-Asian ethnicity (HR 2.8), male sex (HR 2.1), baseline HBVDNA ≤10 000 (HR 2.0) and age >45 (HR 1.8) were significant independent predictors of seroclearance.
  
  
  
  HBsAg seroclearance rates were lower than previously described in this real-life cohort of patients with chronic hepatitis B, especially among Asian, female and younger patients.
authors.affiliation: Department of Medicine, Stanford University Medical Center, Palo Alto, CA, USA.|Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: L H
authors.initials: LH
authors.lastname: Nguyen
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Hoang
authors.affiliation: Department of Medicine, University of California, San Diego, San Diego, CA, USA.
authors.forename: N H
authors.initials: NH
authors.lastname: Nguyen
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.
authors.forename: V D
authors.initials: VD
authors.lastname: Vu
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.
authors.forename: C
authors.initials: C
authors.lastname: Wang
authors.affiliation: San Jose Gastroenterology, San Jose, CA, USA.
authors.forename: H N
authors.initials: HN
authors.lastname: Trinh
authors.affiliation: Department of Gastroenterology, Palo Alto Medical Foundation, Mountain View, CA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Li
authors.affiliation: Chinese Hospital, San Francisco, CA, USA.
authors.forename: J Q
authors.initials: JQ
authors.lastname: Zhang
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.
authors.forename: M H
authors.initials: MH
authors.lastname: Nguyen
mesh_terms: D000328:Adult; D004279:DNA, Viral / Q000097:blood; D005006:Ethnicity; D005260:Female; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D006515:Hepatitis B virus / Q000235:genetics; D019694:Hepatitis B, Chronic / Q000097:blood* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies
chemical_list: D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens