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Abstract Details
Clearance of hepatitis B "e" antigen in untreated chronic HBV infection: a systematic review and meta-analysis
J Infect Dis. 2022 May 2;jiac168. doi: 10.1093/infdis/jiac168. Online ahead of print.
1Medical Practice Evaluation Center, Massachusetts General Hospital. Boston, MA, USA.
2Division of Infectious Diseases, Massachusetts General Hospital. Boston, MA, USA.
3Harvard Medical School. Boston, MA., USA.
4Division of Gastroenterology, Hepatology, and Endoscopy, Brigham & Women's Hospital. Boston, MA, USA.
5Department of Dermatology and Infectious Diseases, UFR des Sciences Médicales, Université Félix Houphouët-Boigny. Abidjan, Côte d'Ivoire.
6Programme PAC-CI, ANRS research site. Abidjan, Côte d'Ivoire.
7Division of General Internal Medicine, Massachusetts General Hospital. Boston, MA, USA.
8Stichting HIV Monitoring, Amsterdam, the Netherlands.
9Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, the Netherlands.
Abstract
Background In people with hepatitis B virus (HBV) infection, persistence of HBV "e" antigen (HBeAg) is associated with clinical progression and need for treatment. HBeAg loss represents partial immune control and is a critical event in the natural history of chronic HBV. Methods We conducted a systematic review and meta-analysis of cohort studies that report HBeAg loss among people with untreated chronic HBV. We evaluated HBeAg loss using a random-effects model and conducted subanalysis on region. Results We screened 10,560 publications, performed 196 full text analyses, and included 26 studies for meta-analysis. The pooled rate of HBeAg loss was 6.46/100 person-years (PYs) (95% CI: 5.17, 8.08). Meta-regression showed that older age of participants and studies in Europe were associated with higher rate of HBeAg loss. Rates were: 7.43/100 PYs (95%CI: 6.30, 8.75; 1 study) in Africa; 3.24/100 PYs (95%CI: 2.61, 4.02; 1 study) in the Eastern Mediterranean; 13.67/100 PYs (95%CI:11.21, 16.66; 4 studies) in Europe; 7.34/100 PYs (95%CI:4.61, 11.70; 5 studies) in North America; 5.53/100 PYs (95%CI:4.05, 7.55; 15 studies) in the Western Pacific. Conclusions Spontaneous HBeAg loss occurs at a rate of 6.46/100 PYs. Variations by region and age group may reflect epidemiological, immunological, or HBV genotype-related differences.