Abstract
BackgroundExpanding antiviral therapy to benefit more populations and optimizing treatment to improve prognoses are two main objectives in current guidelines on antiviral therapy. However, the guidelines do not recommend antiviral therapy for inactive hepatitis B surface antigen (HBsAg) carriers (IHCs). Recent studies have shown that antiviral therapy is effective with good treatment outcomes in IHC populations. We conducted a systematic review and meta-analysis of HBsAg clearance and conversion in IHCs.MethodsWe searched PubMed, Embase, Medline, and Web of Science to retrieve articles on HBsAg clearance in IHCs published between January 2000 and August 2021. Data were collected and analysed using the random-effects model for meta-analysis.ResultsA total of 1029 IHCs from 11 studies were included in this analysis. The overall HBsAg clearance rate was 47% (95% confidence interval (CI): 31% - 64%), with a conversion rate of 26% (95% CI: 15% - 38%) after 48 weeks of Pegylated interferon (Peg-IFN) treatment. In the control group (including nucleos(t)ide analogue (NA) treatment or no treatment), the overall HBsAg clearance rate was only 1.54% (95% CI: 0.56% - 3.00%), which was markedly lower than that in the Peg-IFN group. Further analysis showed that a low baseline HBsAg level and long treatment duration contributed to a higher HBsAg clearance rate.ConclusionThis study showed that treatment of IHCs can be considered to achieve a clinical cure for chronic hepatitis B virus (HBV) infection. After Peg-IFN treatment, the HBsAg clearance rate was 47%, and the conversion rate was 26%, which are markedly higher than those reported by previous studies on Peg-IFN treatment in patients with chronic hepatitis B (CHB). A low baseline HBsAg level and long treatment duration were associated with HBsAg clearance in IHCs. Therefore, antiviral therapy is applicable for IHCs, a population who may be clinically cured.Systematic Review Registration http://www.crd.york.ac.uk/PROSPERO, CRD): CRD42021259889.
Highlights
Chronic hepatitis B virus (HBV) infection is an important cause of liver cirrhosis and hepatocellular carcinoma (HCC) [1]
The overall hepatitis B surface antigen (HBsAg) clearance rate was 47% (95% confidence interval (CI): 31% - 64%), with a conversion rate of 26% after 48 weeks of Pegylated interferon (PegIFN) treatment
In the control group (including nucleos(t)ide analogue (NA) treatment or no treatment), the overall HBsAg clearance rate was only 1.54%, which was markedly lower than that in the pegylated interferon (Peg-IFN) group
Summary
Chronic hepatitis B virus (HBV) infection is an important cause of liver cirrhosis and hepatocellular carcinoma (HCC) [1] To reduce this major threat, two main trends are evident in current Chinese and international guidelines on antiviral therapy for the prevention and treatment of chronic hepatitis B (CHB): 1) the use of de-escalation therapy by relaxing the treatment criteria, allowing more patients to receive treatment and improving the prognosis; and 2) optimization of clinical clearance and treatment outcomes in the appropriate populations. The guidelines do not recommend antiviral therapy for inactive hepatitis B surface antigen (HBsAg) carriers (IHCs) [2,3,4], whereas studies [5, 6] in Asian populations have suggested that treating IHC patients is important, mainly because Asian patients usually have a long disease course by the IHC stage, and a risk of developing cirrhosis and HCC remains without treatment. We conducted a systematic review and meta-analysis of HBsAg clearance and conversion in IHCs
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