HBsAg Seroconversion May Not be a Durable Event in the Course of Chronic HBV Infection in Adults

Abstract

Background: HBsAg sero-clearance with or without appearance of anti-HBs is considered to be a functional cure in chronic HBV infected individuals. However data regarding durability of HBsAg sero-clearance is limited. Methods: We retrospectively analyzed chronic HBV infected patients who had cleared HBsAg during their follow up, either spontaneously or on antiviral treatment. Results: Of the 270 patients with chronic HBV infection, 15(5.5%) lost HBsAg after a median of 60 months(9-110) of follow up. The mean age of the cohort was 49.5(12.2) years ,12 (80%) were males and 4(26%)were HBeAg positive. The baseline Median ALT, HBV DNA load and liver stiffness was 41.5 (16-1134) IU/L, 140000 (622-100000000) IU/ml and 8.05(5.3-35.3) kPa respectively. 12 (80%) cleared HBsAg while being on NUCs( 10 entocavir, 1 TAF, 1 adefovir, none of our pt received peg interferon) and 3 achieved spontaneous HBsAg sero-clearance. Of all patients who cleared the virus, 33% were cirrhotic (13%compensated and 20 % decompensated). 7(46.6% achieved Anti-HBs antibodies > 10 mIU/ml, after a medain of 8 (0-166) months after clearance of HBsAg. HBsAg sero-reversion occurred in 5(33.3%). All patients who had seroreversion were on entecavir. The median time from HBsAg detection to HBsAg clearance was 60 months in both the groups, i.e those who had seroreversion and those who continued to have clearance. In 4(80%) sero-reversion occurred after stopping antivirals. 1 patient who had seroreversion had received steroids for autoimmune hemolytic anemia. On the other hand none of the spontaneously serocleared patients developed sero-reversion. The anti HBsAb titre was >10mIU/ml in 2(40%) of those who had seroreversion. Conclusion: HBsAg seroclearance is not durable in one third of adult patients with chronic hepatitis B infection, especially if it induced by Nucleos(t)ide analogue therapy.