Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
J Viral Hepat. 2020 Sep;27(9):922-931. doi: 10.1111/jvh.13312. Epub 2020 Jul 2.
The prevalence of concurrent HBsAg and anti-HBs in plasma of persons with chronic hepatitis B virus (HBV) infection is variable and its clinical significance enigmatic. We examined the prevalence and clinical and virological features of concurrent HBsAg and anti-HBs in children and adults with chronic HBV infection living in North America. A total of 1462 HBsAg positive participants in the Hepatitis B Research Network paediatric and adult cohorts were included (median age 41 (range 4-80) years, 48% female, 11% white, 13% black, 73% Asians). Only 18 (1.2%) were found to be anti-HBs positive (≥10 mIU/mL) at initial study evaluation. Distributions of sex, race, HBV genotype and ALT were similar between participants with and without concurrent anti-HBs. Those who were anti-HBs positive appeared to be older (median age 50 vs 41 years, P = .06), have lower platelet counts (median 197 vs 222 × 103/mm , P = .07) and have higher prevalence of HBeAg (44% vs 26%, P = .10). They also had lower HBsAg levels (median 2.0 vs 3.5 log IU/mL, P = .02). Testing of follow-up samples after a median of 4 years (range 1-6) in 12 of the 18 participants with initial concurrent anti-HBs showed anti-HBs became undetectable in 6, decreased to <10 mIU/mL in 1 and remained positive in 5 participants. Two patients lost HBsAg during follow-up. In conclusion, prevalence of concurrent HBsAg and anti-HBs was low at 1.2%, with anti-HBs disappearing in some during follow-up, in this large cohort of racially diverse children and adults with chronic HBV infection living in North America. Presence of concurrent HBsAg and anti-HBs did not identify a specific phenotype of chronic hepatitis B, nor did it appear to affect clinical outcomes.
在慢性乙型肝炎病毒 (HBV) 感染者的血浆中，同时存在乙型肝炎表面抗原 (HBsAg) 和抗 -HBs 的流行率是可变的，其临床意义也难以捉摸。我们研究了生活在北美的慢性 HBV 感染的儿童和成人中同时存在 HBsAg 和抗 -HBs 的流行率以及临床和病毒学特征。共有 1462 名 HBsAg 阳性的乙型肝炎研究网络儿科和成人队列参与者被纳入研究（中位年龄 41 岁（范围 4-80 岁），48%为女性，11%为白人，13%为黑人，73%为亚洲人）。在最初的研究评估中，只有 18 名（1.2%）被发现抗 -HBs 阳性（≥10 mIU/mL）。同时存在抗 -HBs 的参与者和不存在抗 -HBs 的参与者之间的性别、种族、HBV 基因型和 ALT 分布相似。那些抗 -HBs 阳性的患者似乎年龄更大（中位年龄 50 岁 vs 41 岁，P=0.06），血小板计数更低（中位数 197 vs 222×103/mm3，P=0.07），HBeAg 阳性率更高（44% vs 26%，P=0.10）。他们的 HBsAg 水平也更低（中位数 2.0 vs 3.5 log IU/mL，P=0.02）。在最初同时存在抗 -HBs 的 18 名参与者中的 12 名，中位随访时间为 4 年（范围 1-6 年）后，对他们的随访样本进行了检测，结果显示有 6 名患者的抗 -HBs 检测结果转为阴性，1 名患者的抗 -HBs 滴度下降至＜10 mIU/mL，5 名患者的抗 -HBs 仍为阳性。有 2 名患者在随访期间丢失了 HBsAg。总之，在这项来自北美的种族多样化的慢性 HBV 感染的儿童和成人的大型队列研究中，同时存在 HBsAg 和抗 -HBs 的流行率较低，为 1.2%，在随访过程中，一些患者的抗 -HBs 消失。同时存在 HBsAg 和抗 -HBs 并不能确定慢性乙型肝炎的特定表型，也似乎不会影响临床结局。
