Hepatitis B cure is characterized by hepatitis B surface antigen (HBsAg) seroclearance and seroconversion. Predictors of spontaneous seroconversion are not well understood.

The present study was therefore designed to determine the predictors of spontaneous HBsAg seroconversion from community practice.

A matched analysis of patients with HBsAg seroconversion (cases) and patients who did not show HBsAg seroconversion (control) was done in a 1:5 ratio based on date of clinic visit from 2014 to 2019 in a community practice. Baseline laboratory and clinical data were obtained and univariate analysis and 2-sided t tests were done.

The study included 14 cases and 70 controls. All the patients were Asians. Statistically significant mean (±SD) baseline differences were evident between cases and controls for HBsAg titers [459.8±311.0 and 782.0±393.3 IU/mL (P=0.01)] as well as for levels of alanine aminotransferase (ALT) [17.6±4.4 and 25.1±16.7 IU/mL (P<0.01)]. Baseline hepatitis B virus DNA and other laboratory values were not different between the two groups. In about 79% of cases and 16% of controls, baseline HBsAg titers were <1000 IU/mL (P<0.01). Logistic regression revealed that HBsAg titers and ALT values predicted HBsAg seroconversion (P=0.01 and <0.01, respectively).

It was thus concluded that spontaneous HBsAg seroclearance and seroconversion is not common in patients with chronic hepatitis B and that the key predictors of seroconversion are HBsAg titers<1000 IU/mL and low baseline ALT values.

Source: Wu CF, Fong TM, Wu SS, Saab S. Hepatitis B Surface Antigen Levels Are Related to Spontaneous Hepatitis B Surface Antigen Seroconversion in Inactive Hepatitis B Carriers. J Clin Gastroenterol. 2020 Jul;54(6):573-576.