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Determinants for hepatitis B e antigen clearance in chronic type B hepatitis
Insights
HBeAg clearance in chronic hepatitis is influenced by hepatitis type, liver damage during exacerbations, and patient sex. Male patients and those with active hepatitis show higher clearance rates.
Area of Science:
- Hepatology
- Virology
- Immunology
Background:
- Chronic hepatitis B infection is a significant global health concern.
- Hepatitis B e-antigen (HBeAg) positivity indicates active viral replication and infectivity.
- HBeAg clearance is a key marker of treatment response and disease remission.
Purpose of the Study:
- To investigate factors influencing HBeAg clearance in HBeAg-positive chronic hepatitis patients.
- To identify predictors of spontaneous HBeAg seroconversion.
- To evaluate the impact of hepatitis histology and patient demographics on HBeAg clearance rates.
Main Methods:
- A 6-year longitudinal study of 237 HBeAg-positive chronic hepatitis patients.
- Monitoring of HBeAg status, SGPT levels, alphafetoprotein, and liver histology.
- Analysis of clearance rates based on hepatitis type, exacerbation severity, and patient sex.
Main Results:
- Annual HBeAg clearance rate was 16%, with a 67% cumulative probability over 5 years.
- HBeAg clearance was preceded by exacerbations (SGPT > 300 IU/L) in 62% of patients, but only 23% of exacerbations led to clearance.
- Alphafetoprotein > 100 ng/ml during exacerbation, chronic active/lobular hepatitis, and male sex were significant predictors of HBeAg clearance.
Conclusions:
- HBeAg clearance is a multifactorial process influenced by time, hepatitis histology, exacerbation severity, and patient sex.
- Specific histological patterns and biochemical markers during exacerbations can predict HBeAg seroconversion.
- Male patients and those with more severe forms of chronic hepatitis exhibit higher rates of HBeAg clearance.
Abstract:
A 6-year (mean 24.5 months) longitudinal study has been undertaken in 237 HBeAg-positive patients with clinicopathologically verified chronic hepatitis. HBeAg clearance occurred in 74 patients at a rate of 16% per year, and a cumulative probability of 67% at the end of a 5-year follow-up. HBeAg clearance was preceded by a temporary "exacerbation" with SGPT greater than 300 IU/L in 62% of the patients. On the other hand, irrespective of the level of SGPT elevation, only 23% of such exacerbations were followed by HBeAg clearance. Further analysis indicates that alphafetoprotein greater than 100 ng/ml, frequently associated with bridging hepatic necrosis, during "exacerbation" predicts HBeAg clearance. In addition, patients with chronic lobular hepatitis and chronic active hepatitis have a higher annual HBeAg clearance rate than patients with chronic persistent hepatitis and nonspecific histologic changes (greater than 15% vs less than 8%, P less than 0.03). Short-term immunosuppressive treatment did not delay HBeAg seroconversion. Male patients had a higher annual HBeAg clearance rate than female patients (18.2% vs 8.7%, P less than 0.05). It was concluded that, in addition to the time factor, the nature of chronic hepatitis, the extent of hepatic damage during "exacerbation", and the sex of the patients are important determinants for HBeAg clearance.