Liver and Bile
J Hepatol. 2023;78(3):524–33
Risk of hepatic decompensation but not hepatocellular carcinoma decreases over time in patients with hepatitis B surface antigen loss
Background and aims: The authors examined the long-term incidence of hepatocellular carcinoma (HCC) and hepatic decompensation among chronic hepatitis B (CHB) patients who have achieved hepatitis B surface antigen (HBsAg) seroclearance.
Methods: All adult CHB-monoinfected patients who cleared HBsAg between January 2000 and December 2020 were identified using a territory-wide database in Hong Kong. Patients who underwent liver transplantation and/or developed HCC before HBsAg seroclearance or less than 6 months follow-up were excluded. The primary and secondary end points were HCC and hepatic decompensation respectively.
Results: 9769 patients with CHB who achieved HBsAg seroclearance (mean age 57 years, 60.0% male, 13.2% cirrhosis) were identified; most had compensated liver function at HBsAg loss. At a median (25th–75th percentile) follow-up of 4.6 (2.2–8.4) years, 106 patients (1.1%) developed HCC. Patients who developed HCC were older, more likely to be male and have cirrhosis, and had higher alanine aminotransferase and lower platelets at the time of HBsAg loss than patients without HCC. The cumulative incidence of HCC remained steady 0–7 and 8–12 years after HBsAg loss (p = 0.898) (crude annual incidence drop: -0.04%, 95% confidence interval [CI]: -0.13–0.04%, p = 0.265). Moreover, 124 of 9640 patients (1.3%) developed hepatic decompensation. The growth in cumulative incidence of hepatic decompensation decelerated 8–12 years after HBsAg loss (p = 0.009) (crude annual incidence drop: -0.23%, 95% CI: -0.40% to -0.06%, p = 0.012). In multivariable analysis, HBsAg loss for over 7 years was associated with a reduced risk of hepatic decompensation (adjusted subdistribution hazard ratio [aSHR] = 0.55, 95% CI: 0.31–0.97, p = 0.039) but not HCC (aSHR = 1.35, 95% CI: 0.83–2.19, p = 0.230).
Conclusion: Risk of hepatocellular carcinoma persists in patients after hepatitis B surface antigen loss, whereas the risk of hepatic decompensation decreases over time.