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TITLE: Spontaneous Surface Antigen Loss in Hepatitis B e Antigen Negative genotype D HBV infection
AUTHORS (LAST NAME, FIRST NAME): Poustchi, Hossein1; Ostovaneh, Mohammad Reza1; Abbasi,
Abdollah2; Khoshnia, Masoud2; Esmaili, Saeed1; Mohamadkhani, Ashraf1; Shayanrad, Amaneh1; Nikmahzar, Aghbibi1; Besharat, Sima1; Keyvani, Hossein3; Pourshams, Akram1; Merat, Shahin1; Malekzadeh, Reza1
INSTITUTIONS (ALL): 1. Digestive Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of. 2. Golestan University of Medical Sciences, Gorgan, Iran, Islamic Republic of. 3. Department of Virology, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of.
ABSTRACT BODY: Background: Hepatitis B virus infection (HBV) is a major health problem worldwide. Iran as an intermediate endemicity country has had a decreasing prevalence during the last decade. We aimed to study the epidemiological features of HBV and the spontaneous loss of hepatitis B surface antigen (HBsAg) in HBV infected (HBeAg negative and genotype D) subjects followed-up during 2003 to 2012. Methods: Golestan cohort study (GCS) is a prospective study of 50,049 adults (58% female, age 40-75 years) originally intended to study the upper GI cancers in North Eastern Iran (2004-2008). GCS subjects are74% Turkmen, 80% live in rural areas, 88% are married,83% are non-smokers, and 70% have no formal education. HBV infection (HBeAg negative and genotype D) was found to be the most common cause of end-stage liver disease during GCS follow-ups. Baseline serology for HBV and HCV infection was obtained for all participants and a subcohort of HBV infected subjects were established within the GCS. Repeated measurements of exposure including HBV infection risk factors and a repeated serologic assessment for markers of HBV infection was performed in 2012 after an average of 5 years from enrollment. Results: A total of 3532 subjects from GCS were found to be HBs Ag positive at baseline and were enrolled in Golestan HBV cohort study. After 5 years of follow–up, 2413 subjects were available for reassessment. Of those, 2123 were found to be HBs Ag positive and 290 subjects were HBs Ag negative (12.0%, annual rate: 2%). Among the 290 subjects with spontaneous loss of HBs Ag, 159 (54.8%) were anti-HBc antibody positive and 71 (24.5%, annual rate: 0.5%) subjects developed anti-HBs antibody. During the average of 5.9 years of follow-up (21107 Person years) 35 HBV infected subjects died of end stage liver disease (annual mortality rate: 1.66 per 1000 persons). Conclusions: HBe Ag negative HBV genotype D infected adults in our cohort had 6 year survival rate of 92.8% with 12.0% chance of spontaneous Loss of HBsAg. |