Liver, Pancreas, and Biliary Tract

Journal of Gastroenterology

, Volume 31, Issue 5, pp 696-701

First online:

Spontaneous hepatitis B surface antigen clearance in a long-term follow-up study of patients with chronic type B hepatitis. Lack of correlation with hepatitis C and D virus superinfection

  • Luiz Caetano Da SilvaAffiliated withDepartment of Gastroenterology (Hepatology Branch), University of São Paulo School of MedicineInstitute of Tropical Medicine (LIM-47 and 52), University of São Paulo School of Medicine
  • , Carmen Lúcia De Assis MadrugaAffiliated withDepartment of Gastroenterology (Hepatology Branch), University of São Paulo School of MedicineInstitute of Tropical Medicine (LIM-47 and 52), University of São Paulo School of Medicine
  • , Flair José CarrilhoAffiliated withDepartment of Gastroenterology (Hepatology Branch), University of São Paulo School of MedicineInstitute of Tropical Medicine (LIM-47 and 52), University of São Paulo School of Medicine
  • , João Renato Rebello PinhoAffiliated withDepartment of Pro-Sangue Foundation, University of São Paulo School of MedicineInstitute of Tropical Medicine (LIM-47 and 52), University of São Paulo School of Medicine
  • , Amadeo Saéz-AlquezarAffiliated withDepartment of Pro-Sangue Foundation, University of São Paulo School of Medicine
  • , Carlos SantosAffiliated withDepartment of Pro-Sangue Foundation, University of São Paulo School of Medicine
  • , Leda BassitAffiliated withDepartment of Pro-Sangue Foundation, University of São Paulo School of Medicine
  • , Claudia BarretoAffiliated withDepartment of Pro-Sangue Foundation, University of São Paulo School of Medicine
  • , Luís Edmundo Pinto Da FonsecaAffiliated withDepartment of Gastroenterology (Hepatology Branch), University of São Paulo School of MedicineInstitute of Tropical Medicine (LIM-47 and 52), University of São Paulo School of Medicine
    • , Venâncio Avancini Ferreira AlvesAffiliated withDepartment of Pathology, University of São Paulo School of Medicine
    • , Regina LeitãoAffiliated withDepartment of Pathology, University of São Paulo School of Medicine
    • , Regina ViannaAffiliated withDepartment of Pathology, University of São Paulo School of Medicine
    • , Rita Antonelli CardosoAffiliated withInstitute of Tropical Medicine (LIM-47 and 52), University of São Paulo School of Medicine
    • , Alex Vianey Callado FrançaAffiliated withDepartment of Gastroenterology (Hepatology Branch), University of São Paulo School of MedicineInstitute of Tropical Medicine (LIM-47 and 52), University of São Paulo School of Medicine
    • , Luiz Carlos Da Costa GayottoAffiliated withDepartment of Pathology, University of São Paulo School of Medicine

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Abstract

We investigated the frequency of HBsAg clearance and the possible role of viral superinfection in a long-term follow-up of 184 patients with chronic hepatitis B (CHB). Our subjects were 184 patients with chronic hepatitis B and the follow-up was 12–216 months (mean 66.2±53.7 months). The investigative methods used were: immunoenzymatic assays for HBV, HCV, HDV, and HIV markers; polymerase chain reaction (PCR) for HBV DNA; and liver biopsy and immunoperoxidase. During the follow-up, 20 of the 184 patients cleared serum HBsAg. A comparison of patients with persistent HBsAg (group I) and of those who cleared this marker (group II) showed a significant difference in mortality (P=0.002) between the two groups and a tendency to a more severe exacerbation (flare) in group II (P=0.07). Antibodies to hepatitis C and D virus as well as antibodies to HIV were equally distributed in both groups. Thirteen patients (7.9%) from group I, but none from group II, subsequently developed hepatocellular carcinoma. These results suggest that the frequency of spontaneous clearance of HBsAg during chronic HBV infection is low. No determinant factor for the clearance was found, including the presence of liver cirrhosis. Serum HBV DNA was undetectable by PCR after clearance in 16 out of 17 patients.

Key words

hepatitis B chronic hepatitis B spontaneous HBsAg clearance