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[Spontaneous HBsAg seroclearance and its determinants in chronic HBV-infected individuals without antiviral

J Qian1, J Jiang1, Y J Chen2

  • 1School of Public Health, Nanjing Medical University, Nanjing 211166, China Major Project Executive Office, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China.

Zhonghua Liu Xing Bing Xue Za Zhi = Zhonghua Liuxingbingxue Zazhi
|March 24, 2026
PubMed

Objective: To clarify the incidence and influencing factors of spontaneous HBsAg seroclearance in community-based chronic HBV-infected individuals. Methods: A total of 5 649 individuals who had never received antiviral treatment were included in this long-term follow-up cohort study. A Fine-Gray competing risk model (F-G model) was used to estimate HBsAg seroclearance incidence and analyze the factors influencing spontaneous HBsAg seroclearance. Results: By the end of 2023 follow-up, a total of 707 participants had achieved spontaneous HBsAg seroclearance in 48 144 person-years of follow-up with the seroclearance rate of 1.47/100 person-years. Analysis using the F-G model demonstrated a higher likelihood of HBsAg seroclearance among: males [sub-distribution hazard ratio (sHR)=1.48, 95%CI: 1.21-1.81, P<0.001], individuals aged 60 years and above (sHR=2.19, 95%CI: 1.21-3.95, P=0.009), obese individuals (sHR=1.38, 95%CI: 1.09-1.74, P=0.007) and HBV DNA-negative individuals (sHR=7.42, 95%CI: 3.89-14.20, P<0.001). Participants with slow decline, slow increase, or significant increase in HBV DNA level had a lower likelihood of HBsAg seroclearance compared to those with significant decline (all P<0.05). Those with high-normal or fluctuating ALT had a lower likelihood of HBsAg seroclearance compared to those with persistently low-normal ALT (both P<0.001). Conclusions: The spontaneous HBsAg seroclearance rate in chronic HBV-infected individuals was relatively low. In the context of expanded antiviral treatment, more strict ALT treatment threshold can be adopted, and the ALT level and HBV DNA level should be continuously monitored to promote HBsAg seroclearance.

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