HBsAg loss in chronic hepatitis B: pointers to the benefits of curative therapy

Excerpt

Hepatitis B surface antigen (HBsAg) clearance is a relatively rare outcome during the complex natural history of chronic hepatitis B [1]. The estimated annual incidence of clearance of HBsAg is 1–2 % in Asian and in Western populations [2]. Annual rates of HBsAg loss in HBeAg-negative patients may be higher in those with lower levels of hepatitis B replication, minimal hepatitis and normal serum aminotransferases [3]. Hepatitis B genotype and mode of acquisition may influence the rate of HBsAg loss. Spontaneous seroclearance of HBsAg is thought to be beneficial, and to confer an improved outlook; thus HBsAg concentrations and loss may be a useful biomarker of prognosis in patients with chronic hepatitis B [4]. HBsAg loss may also occur, although relatively rarely, after interferon-alpha treatment or nucleoside analogue anti-viral therapy [5‐7]. Likewise, the prognosis is improved, and thus HBsAg loss, rather than merely HBV DNA suppression, has become an important goal of potential curative therapies for hepatitis B. …