Incidence and prediction of HBsAg seroclearance in a prospective multi-ethnic HBeAg-negative chronic hepatitis B cohort.

Abstract

BACKGROUND AND AIMS:

Achieving HBsAg loss is an important landmark in the natural history of chronic hepatitis B (CHB). A more personalized approach to prediction of HBsAg loss is relevant in counseling patients. This study sought to develop and validate a prediction model for HBsAg loss based on quantitative HBsAg levels (qHBsAg) and other baseline characteristics.

METHODS:

The Hepatitis B Research Network (HBRN) is a prospective cohort including 1240 untreated HBeAg-negative patients (1150 adults, 90 children) with median follow-up of 5.5 years. Incidence rates of HBsAg loss and hepatitis B surface antibody (anti-HBs) acquisition were determined, and a predictor score of HBsAg loss using readily available variables was developed and externally validated.

RESULTS:

Crude incidence rates of HBsAg loss and anti-HBs acquisition were 1.6 and 1.1 per 100 person-years (PY); 67 achieved sustained HBsAg loss for an incidence rate of 1.2 per 100 PY. Increased HBsAg loss was significantly associated with older age, non-Asian race, HBV phenotype (inactive CHB vs. others), HBV genotype A, lower HBV-DNA levels, and lower and greater change in qHBsAg. The HBRN-SQuARe (sex,∆quantHBsAg, age, race) score predicted HBsAg loss over time with area under the receiver operating characteristic curve (AUROC) (95% CIs) at 1 and 3 years of 0.99 (95% CI: 0.987-1.00) and 0.95 (95% CI 0.91-1.00), respectively. In validation in another cohort of 1253 HBeAg-negative patients with median follow-up of 3.1 years, HBRN SQuARe predicted HBsAg loss at 1 and 3 years with AUROC values of 0.99 (0.98-1.00) and 0.88 (0.77-0.99), respectively.

CONCLUSION:

HBsAg loss in predominantly untreated patients with HBeAg-negative CHB can be accurately predicted over a 3-year horizon using a simple validated score (HBRN SQuARe). This prognostication tool can be used to support patient care and counseling.

• Authors: Norah A Terrault, Abdus S Wahed, Jordan J Feld, Stewart L Cooper, Mark G Ghany, Mauricio Lisker-Melman, Robert Perrillo, Richard K Sterling, Mandana Khalili, Raymond T Chung, Philip Rosenthal, Robert J Fontana, Arif Sarowar, Daryl T Y Lau, Junyao Wang, Anna S Lok, Harry L A Janssen
• Journal: Hepatology (Baltimore, Md.) (Hepatology) Vol. 75 Issue 3 Pg. 709-723 (03 2022) ISSN: 1527-3350 [Electronic] United States
• PMID: 34743343 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: © 2021 American Association for the Study of Liver Diseases.

Chemical References

• Hepatitis B Antibodies
• Hepatitis B Surface Antigens

Topics

• Adult
• Age Factors
• Child
• Ethnicity (statistics & numerical data)
• Female
• Follow-Up Studies
• Hepatitis B Antibodies (analysis, blood)
• Hepatitis B Surface Antigens (analysis, blood, immunology)
• Hepatitis B virus (genetics)
• Hepatitis B, Chronic (diagnosis, immunology)
• Humans
• Incidence
• Male
• Predictive Value of Tests
• Prognosis
• Serologic Tests (methods, statistics & numerical data)
• Sustained Virologic Response