Search

Background Hepatitis B surface antigen ( HBsAg) positivity is associated with increased risk for cirrhosis and hepatocellular carcinoma ( HCC). HBsAg seroclearance is thought to be rare in general, but cohort data from US patients are limited. Aim To determine the incidence of HBsAg seroclearance in a real-life US cohort. Methods In total, 4737 patients with chronic hepatitis B from five primary care, gastroenterology and multispecialty centres, and a university medical centre were retrospectively enrolled between 2001 and 2014 with data obtained by manual review of individual patient medical records. Seroclearance was determined by loss of HBsAg seropositivity. Persistent HBsAg was confirmed by direct serology or by proxy with positive hepatitis B e-antigen ( HBeAg) or HBV DNA levels. Results HBsAg seroclearance occurred in 52 patients over 16 844 person-years (0.31% annually, 1.2% overall). Median follow-up was 32 months, and mean age 45 ± 14 years. Incidence of HBsAg seroclearance was higher in non-Asians, age >45, males, and those with baseline HBV DNA ≤10 000 IU/mL. On multivariate Cox proportional modelling, non-Asian ethnicity ( HR 2.8), male sex ( HR 2.1), baseline HBVDNA ≤10 000 ( HR 2.0) and age >45 ( HR 1.8) were significant independent predictors of seroclearance. Conclusion HBsAg seroclearance rates were lower than previously described in this real-life cohort of patients with chronic hepatitis B, especially among Asian, female and younger patients. [ABSTRACT FROM AUTHOR]

Background Chronic hepatitis B ( CHB) may lead to cirrhosis, hepatocellular carcinoma and premature death. Elevated alanine transaminase ( ALT) levels ≥ the upper limit of normal ( ULN) are a major determinant for initiating anti-viral therapy; however, ALT levels alone may not be predictive of hepatic fibrosis. Aim To determine the proportion of CHB patients with ALT ≤40 IU/L and liver fibrosis stage ≥2. Secondary goals include subgroup analysis by hepatitis B e antigen ( HBeAg) status, high hepatitis B virus ( HBV) DNA levels, Asian ethnicity, lower ULN of ≤30 IU/L (males) and 19 IU/L (females), and advanced age. Methods Studies identified in EMBASE and MEDLINE (1/1990-6/2012) using the search criteria: 'Hepatitis B'[Mesh] OR 'Hepatitis B virus'[Mesh] OR 'Hepatitis B, Chronic'[Mesh])) AND 'Alanine Transaminase'[Mesh]) and abstracts containing the term 'hepatitis' from recent major U.S. gastroenterology and liver society meetings were considered. Results Among nine studies ( N = 830 patients), a significant proportion (20.7%; 95% CI: 16.2-26.0%) of CHB patients with ALT levels ≤40 IU/L had significant fibrosis irrespective of HBeAg status, high HBV DNA levels, ethnicity or age, although this proportion may be higher in patients older than 30-40 years old. The corresponding proportion was 27.8% even when the newer ULN of 30 IU/L (males) and 19 IU/L (females) was applied. Conclusions Approximately one fifth of CHB patients with ALT ≤40 IU/L may have significant hepatic fibrosis. The approach to such patients should be individualised, as further evaluation and treatment may be appropriate. [ABSTRACT FROM AUTHOR]

Background One of the most important factors in treatment failure using nucleos(t)ide analogues in chronic hepatitis B is anti-viral resistance. Primary drug resistance refers to amino acid changes in the hepatitis B virus polymerase/reverse transcriptase (rt) that result in reduced susceptibility to anti-viral agents. Pre-existing drug resistance mutations may occur in untreated patients and may affect their treatment outcomes. Aim To determine the prevalence of hepatitis B DNA polymerase mutations in treatment-naïve patients. Methods We used a direct PCR sequencing test to detect DNA polymerase mutations in 472 consecutive treatment-naïve patients at two community gastroenterology clinics in Northern California. Results A majority of patients were Asians (>95%), had either genotype B or C (95%) and had no evidence of cirrhosis or liver cancer (94%). Mean age was 45 ± 13 and mean hepatitis B virus DNA was 5.3 ± 1.8 log10 IU/mL. Most patients did not have any detectable mutations (82.4%). Some (16.7%) had mutations of unknown clinical significance (rtV207M/L/I) and only 4 patients had rtA181A/S, rtA194S or M250I. Conclusions No rtM204V/I or rtN236T mutations were observed in our study. Less than 1% of our patients had mutations that can be associated with primary resistance to existing anti-viral therapies for hepatitis B virus. [ABSTRACT FROM AUTHOR]