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HBsAg clearance in chronic active hepatitis B. A possible cause of cryptogenic cirrhosis
Insights
Chronic hepatitis B infection can lead to cirrhosis, even after the virus is cleared and antibodies develop. This suggests hepatitis B may be an underrecognized cause of cryptogenic cirrhosis.
Area of Science:
- Hepatology
- Virology
- Gastroenterology
Background:
- Chronic hepatitis B infection is a significant global health concern.
- Cirrhosis is a late stage of liver disease characterized by scarring.
Observation:
- Three patients with chronic hepatitis B infection (two with chronic active hepatitis and cirrhosis, one with quiescent cirrhosis) spontaneously cleared hepatitis B surface antigen (HBsAg).
- These patients subsequently developed antibodies to hepatitis B surface antigen (anti-HBs).
Findings:
- Following HBsAg clearance and anti-HBs development, patients were asymptomatic with near-normal liver enzymes.
- Liver biopsies confirmed cirrhosis in all three patients.
- Serologically, these patients were indistinguishable from those with cryptogenic cirrhosis and prior hepatitis B exposure.
Implications:
- Remote chronic hepatitis B infection is a potential, often overlooked, cause of cryptogenic cirrhosis.
- This finding may necessitate re-evaluation of patients diagnosed with cryptogenic cirrhosis.
- Understanding the long-term outcomes of hepatitis B infection is crucial for liver disease management.
Abstract:
Three patients with chronic hepatitis B infection, two with chronic active hepatitis and cirrhosis, and the third with quiescent cirrhosis, cleared HBsAg from their serum and eventually developed anti-HBs. All three were asymptomatic and had nearly normal serum aminotransferases following loss of HBsAg. Liver biopsy revealed cirrhosis in each patient. With the development of anti-HBs, these patients became serologically indistinguishable from patients with a cryptogenic cirrhosis who had prior unrelated exposure to hepatitis B. Remote chronic hepatitis B infection may be a more common cause of cryptogenic cirrhosis than is commonly appreciated.