DELAYED CLEARANCE OF SERUM HBSAG IN COMPENSATED CIRRHOSIS-B - RELATION TO INTERFERON-ALPHA THERAPY AND DISEASE PROGNOSIS

Objective: The aim of this study was to evaluate the incidence, progno stic factors and clinical significance of delayed clearance of serum H BsAg in compensated cirrhosis B.,Methods: This was a retrospective coh ort study of 309 consecutive white patients with biopsy-proved compens ated cirrhosis type B. Results: During a mean follow-up of 68 months, HBsAg loss occurred in 32 patients, including 16 (8%) of 196 untreated patients (mean annual incidence 0.8%), 8 (10%) of 82 interferon (IFN) alpha-treated patients and eight patients who had been treated with o ther antivirals or steroids. The 5-yr probability of HBsAg loss was 4% and 16% for untreated and IFN-treated patients, respectively (p = 0.0 001). Cox's regression analysis identified hepatitis B e antigen-posit ivity at entry as the sole independent prognostic factor for HBsAg los s. Of the 32 patients who lost HBsAg, one (3%) subsequently developed hepatocellular carcinoma (HCC) and died, whereas, among the patients w ho remained HBsAg-positive, 11% developed HCC and 20% had died. The pr obability of HCC appearance was lower (p = 0.0137) and survival was lo nger (p = 0.0006) in patients who cleared HBsAg compared with patients with HBsAg persistence. Conclusion: The incidence of HBsAg loss is ab out 0.8% in cirrhosis type B. Prognostic factors for clearance of HBsA g are initial HBeAg positivity and therapy with alpha interferon. Pati ents with cirrhosis type B, who lose HBsAg, have a low risk for liver cancer or liver-related death. (C) 1998 by Am. Coll. of Gastroenterolo gy.