Author information
- 1Section of Hepatology, Virginia Commonwealth University, Richmond.
- 2Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh.
- 3Infectious Disease Research Abbott, Abbott Park, IL.
- 4Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
- 5Division of Digestive and Liver Diseases, UT Southwestern Medical Center at Dallas, Dallas, TX, USA. Electronic address: william.lee@utsouthwestern.edu.
Abstract
Background: Acute hepatitis B virus (aHBV) is thought to be self-limited with clearance of HBsAg within 6 months. There are limited reports of the presenting features and outcomes of adults with symptomatic aHBV in the U.S.
Patients and methods: Demographics, clinical features and 12-month outcomes of patients with adjudicated aHBV were captured prospectively and compared to a contemporaneous cohort of chronic HBV (cHBV) cases enrolled in the Hepatitis B Research Network.
Results: Between 2011 and 2018, 60 adjudicated aHBV were compared to 1534 cHBV untreated controls. Although similar in age, other features were dissimilar: aHBV subjects were more often male (72% vs. 51%), single (72% vs. 30%), non-Hispanic whites or blacks (75% vs. 24%). They also were frequently genotype A2 (65% vs. 9%) having different risk factors: sexual exposure (75% vs. 16%) or injection drug use (10% vs. 2%), compared to the cHBV controls. In addition to higher serum aminotransferase and bilirubin levels, acute cases had higher HBV DNA levels (4.8 vs. 3.6 log10 IU/mL) while quantitative HBeAg levels were lower (1.4 vs. 3.0 log10 IU/mL) despite higher rates of HBeAg (73% vs. 25%). The median time to HBsAg clearance was 27 weeks and to anti-HBs appearance, 41 weeks.
Conclusions: In the current era, Caucasian men infected with genotype A2 as a result of sexual exposure or injection drug use were the predominant group in aHBV, suggesting a potential strategy for adult vaccination in North America. Strikingly, only an estimated 36% of subjects cleared HBsAg by month 6; the definition of resolution in acute hepatitis B may need to be modified. ClinicalTirals.gov number NCT01263587.