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. 2023 Jul;21(7):1881-1892.e4.
doi: 10.1016/j.cgh.2022.09.004. Epub 2022 Sep 16.

Acute Hepatitis B Virus Infection in North American Adults

Richard K Sterling  1 , Abdus S Wahed  2 , Gavin Cloherty  3 , Jay H Hoofnagle  4 , William M Lee  5 ; Hepatitis B Research Network Investigators
Affiliations

Acute Hepatitis B Virus Infection in North American Adults

Richard K Sterling et al. Clin Gastroenterol Hepatol. 2023 Jul.

Abstract

Background & aims: Acute hepatitis B virus (aHBV) is thought to be self-limited with clearance of hepatitis B surface antigen (HBsAg) within 6 months. There are limited reports of the presenting features and outcomes of adults with symptomatic aHBV in the United States.

Methods: Demographics, clinical features, and 12-month outcomes of patients with adjudicated aHBV were captured prospectively and compared with a contemporaneous cohort of chronic HBV (cHBV) patients enrolled in the Hepatitis B Research Network.

Results: Between 2011 and 2018, 60 adjudicated patients with aHBV were compared with 1534 cHBV untreated controls. Although similar in age, other features were dissimilar: aHBV patients were more often male (72% vs 51%), single (72% vs 30%), and 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 with the cHBV controls. In addition to higher serum aminotransferase and bilirubin levels, acute patients had higher HBV DNA levels (4.8 vs 3.6 log10 IU/mL), whereas quantitative hepatitis B e antigen (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.

Keywords: Hepatitis B; Risk Factors; Seroconversion.

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Conflict of interest statement

Conflict of interest statement (for all authors): Dr. Lee receives research support from Merck, Conatus, Intercept, Bristol-Myers Squibb, Novo Nordisk, Synlogic, Eiger, Cumberland, Exalenz, Instrumentation Laboratory and Ocera Therapeutics, now Mallinckrodt Pharmaceuticals. He has consulted for Genentech, Seattle Genetics, Forma, Inc., Affibody, Karuna and Cortexyme. Dr. Sterling receives grant support from Roche, Abbott, Abbvie, and Gilead. Dr. Abdus has nothing to disclose.

Figures

Figure 1.
Figure 1.
Cumulative proportion of HBsAg loss and anti-HBs development.
Figure 2.
Figure 2.
Loss of HBsAg by HBeAg status.
Figure 3.
Figure 3.
Cumulative proportion of HBsAg loss by HBV DNA level.
See this image and copyright information in PMC

References

    1. Polaris Observatory Collaborators. Global prevalence, treatment, and prevention of hepatitis B virus infection in 2016: a modelling study. Lancet Gastroenterol Hepatol 2018;3:383–403. - PubMed
    1. Le MH, Yeo YH, Cheung R, Henry L, Lok AS, Nguyen MH. Chronic hepatitis B prevalence among foreign-born and U.S.-born adults in the United States, 1999-2016. Hepatology 2019;71:431–443. - PubMed
    1. Kowdley KV, Wang CC, Welch S, Roberts H, Brosgart CL. Prevalence of chronic hepatitis B among foreign-born persons living in the United States by country of origin. Hepatology 2012;56:422–433. - PubMed
    1. Centers for Disease Control and Prevention. Viral hepatitis surveillance—United States, 2017. Atlanta: US: Department of Health and Human Services, Centers for Disease Control and Prevention; 2019. Available at: https://www.cdc.gov/hepatitis/statistics/2017surveillance/index.htm.
    1. Iqbal K, Klevens RM, Kainer MA, Baumgartner J, Gerard K, Poissant T, et al. Epidemiology of acute hepatitis B in the United States from population-based surveillance, 2006-2011. Clin Inf Dis 2015;61:584–592. - PubMed

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