Coexistence of low levels of HBsAg and high levels of anti-HBs may increase risk of hepatocellular carcinoma in chronic hepatitis B patients with high HBV load.

Abstract

OBJECTIVE\nThe clinical significance of coexistence of HBsAg/anti-HBs in chronic hepatitis B (CHB) patients remains controversial. This study was aimed to assess the association of this serological pattern with hepatocellular carcinoma (HCC) in patients with CHB.\n\n\nMETHODS\nIn this cross-section study, 206 CHB patients with coexistence of HBsAg/anti-HBs and 206 CHB patients with HBsAg alone were included to evaluate the risk of HCC development by logistic regression analysis. In addition, a retrospective cohort of 260 patients with CHB was recruited to estimate the cumulative incidence of HCC by Kaplan-Meier analysis.\n\n\nRESULTS\nThe serological pattern of coexistence of HBsAg/anti-HBs, with high levels of ( High ) HBsAg/low levels of ( Low ) anti-HBs, were considered as independent risk factors for HCC. In particular, patients with High HBsAg/ High anti-HBs [odds ratio (OR), 4.295; 95% confidence interval (CI), 1.104-16.699; p\u202f=\u202f0.035] and Low HBsAg/ High anti-HBs (OR, 3.207; 95%CI, 1.299-7.919; p\u202f=\u202f0.012) exhibited significantly higher risk for HCC development. However, only Low HBsAg / High anti-HBs might increase risk of HCC in CHB patients with high HBV load (logrank p\u202f<\u202f0.001) in our cohort study.\n\n\nCONCLUSION\nThe coexistence of Low HBsAg / High anti-HBs might increase the risk of HCC development in CHB patients with high HBV load, which reflected that the long-term interaction between immune response and virus might lead to the development of HCC. The identification of the patients with poor prognosis will help clinicians to refine the therapeutic decisions and individualize follow-up strategies.