Abstract
The coexistence of HBsAg and anti-HBs has been reported in some chronic hepatitis B patients; however, the long-term outcomes of this serological profile have not been elucidated. We aimed to evaluate the long-term outcomes of HBsAg/anti-HBs double-positive chronic hepatitis B patients. Chronic hepatitis B patients who underwent baseline abdominal ultrasonography and follow-up (HBsAg/anti-HBs assessment and abdominal ultrasonography) at our healthcare center were included. The “coexistence group” included patients positive for both HBsAg and anti-HBs and the “control group” included patients positive for only HBsAg during follow-up. The outcomes were hepatocellular carcinoma (HCC) incidence, HBsAg seroclearance and overall mortality. Kaplan-Meier and Cox proportional hazard regression analyses were performed. Of the 2,341 eligible patients, 166 (7.1%) were in the coexistence group. The total follow-up duration was 5.4 years. The coexistence group had a 3.08-fold higher risk of HCC than the control group [hazard ratio (HR) 3.08, 95% confidence interval(CI) 1.26–7.55, P = 0.014] in multivariate analysis. The coexistence group had more HBsAg seroclearance than the control group (HR 1.43, 95% CI 1.01–2.03, P = 0.046). However, overall mortality did not significantly differ between the 2 groups. The coexistence group is heterogeneous and includes subjects with unfavorable outcomes (incidence of HCC) and favorable outcomes (more HBsAg seroclearance).
Highlights
The natural course of hepatitis B virus (HBV) infection is determined by the interrelationship between viral replication and host immunity
The coexistence group accounted for 7.1% of the total population
There were no significant differences in age, sex, alanine aminotransferase (ALT) level, aspartate aminotransferase (AST) level, presence of cirrhosis, FIB-4 or history of antiviral medication
Summary
The natural course of hepatitis B virus (HBV) infection is determined by the interrelationship between viral replication and host immunity. The serological detection of viral proteins (hepatitis B surface antigen (HBsAg)) and host-produced antibodies (anti-HBs) is usually performed to evaluate the status of HBV infection. The HBsAg/anti-HBs double-positive serological profile is observed in several clinical situations. The prevalence of HBsAg and anti-HBs double-positive serological profiles was reported to vary from 2.8 to 3.6% among different cohorts[2,3,4,5]. The clinical significance and long-term outcomes of this coexistence of HBsAg and anti-HBs has not been well established. Several other studies have showed no association between the coexistence of HBsAg and anti-HBs and the severity of chronic liver disease[8,9]. The aim of this study was to determine the long-term outcomes of the coexistence of HBsAg and anti-HBs
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