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Title: Factors Associated With Rates of HBsAg Seroclearance in Adults With Chronic HBV Infection: A Systematic Review and Meta-analysis
Authors: Yee Hui Yeo
Hsiu J. Ho
Hwai I. Yang
Tai Chung Tseng
Tetsuya Hosaka
Huy N. Trinh
Min Sun Kwak
Young Min Park
James Yan Yue Fung
Maria Buti
Manuel Rodríguez
Sombat Treeprasertsuk
Carmen Monica Preda
Teerapat Ungtrakul
Phunchai Charatcharoenwitthaya
Xiangyong Li
Jiayi Li
Jian Zhang
Michael Huan Le
Bin Wei
Biyao Zou
An Le
Donghak Jeong
Nicholas Chien
Leslie Kam
Chiao Chin Lee
Mar Riveiro-Barciela
Doina Istratescu
Tassanee Sriprayoon
Yutian Chong
Tawesak Tanwandee
Mariko Kobayashi
Fumitaka Suzuki
Man Fung Yuen
Hyo Suk Lee
Jia Horng Kao
Anna S. Lok
Chun Ying Wu
Mindie H. Nguyen
Academia Sinica, Genomics Research Center
Daejin Medical Center
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas
National Taiwan University Hospital
Palo Alto Medical Foundation
Chulalongkorn University
University of Michigan, Ann Arbor
National Taiwan University College of Medicine
University of California, San Francisco
Sun Yat-Sen University
Seoul National University Hospital
Hospital Universitario Central de Asturias
Toranomon Hospital
Stanford University Medical Center
Veterans General Hospital-Taipei
Institutul Clinic Fundeni
Hospital Universitari Vall d'Hebron
Kaohsiung Medical University
Triservice General Hospital Taiwan
Faculty of Medicine, Siriraj Hospital, Mahidol University
China Medical University Taichung
The University of Hong Kong
Chulabhorn Royal Academy
Chinese Hospital
San Jose Gastroenterology
Keywords: Medicine
Issue Date: 1-Feb-2019
Citation: Gastroenterology. Vol.156, No.3 (2019), 635-646.e9
Abstract: © 2019 AGA Institute Background & Aims: Seroclearance of hepatitis B surface antigen (HBsAg) is a marker for clearance of chronic hepatitis B virus (HBV) infection, but reported annual incidence rates of HBsAg seroclearance vary. We performed a systematic review and meta-analysis to provide more precise estimates of HBsAg seroclearance rates among subgroups and populations. Methods: We searched PubMed, Embase, and the Cochrane library for cohort studies that reported HBsAg seroclearance in adults with chronic HBV infection with more than 1 year of follow-up and at least 1 repeat test for HBsAg. Annual and 5-, 10-, and 15-year cumulative incidence rates were pooled using a random effects model. Results: We analyzed 34 published studies (with 42,588 patients, 303,754 person-years of follow-up, and 3194 HBsAg seroclearance events), including additional and updated aggregated data from 19 studies. The pooled annual rate of HBsAg seroclearance was 1.02% (95% CI, 0.79–1.27). Cumulative incidence rates were 4.03% at 5 years (95% CI, 2.49–5.93), 8.16% at 10 years (95% CI, 5.24–11.72), and 17.99% at 15 years (95% CI, 6.18–23.24). There were no significant differences between the sexes. A higher proportion of patients who tested negative for HBeAg at baseline had seroclearance (1.33%; 95% CI, 0.76–2.05) than those who tested positive for HBeAg (0.40%; 95% CI, 0.25–0.59) (P <.01). Having HBsAg seroclearance was also associated with a lower baseline HBV DNA level (6.61 log 10 IU/mL; 95% CI, 5.94–7.27) vs not having HBsAg seroclearance (7.71 log 10 IU/mL; 95% CI, 7.41–8.02) (P <.01) and with a lower level of HBsAg at baseline (2.74 log 10 IU/mL; 95% CI, 1.88–3.60) vs not having HBsAg seroclearance (3.90 log 10 IU/mL, 95% CI, 3.73–4.06) (P <.01). HBsAg seroclearance was not associated with HBV genotype or treatment history. Heterogeneity was substantial across the studies (I 2 = 97.49%). Conclusion: In a systematic review and meta-analysis, we found a low rate of HBsAg seroclearance in untreated and treated patients (pooled annual rate, approximately 1%). Seroclearance occurred mainly in patients with less active disease. Patients with chronic HBV infection should therefore be counseled on the need for lifelong treatment, and curative therapies are needed.
ISSN: 15280012
Appears in Collections:Scopus 2019

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