Prevalence of Cirrhosis/Advanced Fibrosis Among HBsAg-Negative and HBcAb-Positive US Adults: A Nationwide Population-Based Study

Abstract

Introduction Evaluation of cirrhosis appears to be easily overlooked in the clinic for the HBsAg-negative (hepatitis B surface antigen-negative) and HBcAb-positive (hepatitis B core antibody-positive) population. Herein, we determine the prevalence of cirrhosis/advanced fibrosis among HBsAg-negative/HBcAb-positive US adults. Methods Data came from the National Health and Nutrition Examination Survey (NHANES) 2001–2018. A total of 3115 HBsAg-negative/HBcAb-positive US adults were enrolled in this study. We assessed cirrhosis by using the Fibrosis-4 (FIB-4) and aspartate aminotransferase to platelet ratio index (APRI) score. Results Out of 50,201 NHANES adults, 45,087 were tested for HBcAb/HBsAg, of whom 3115 met the inclusion criteria (HBsAg-negative/HBcAb-positive with available data for FIB-4/APRI). The weighted proportion of HBsAg-negative/HBcAb-positive among US adults was 4.46% (95% CI 4.17–4.75%), affecting 9.87 million US adults. According to the results of the FIB-4, the weighted prevalence of cirrhosis/advanced fibrosis among HBsAg-negative/HBcAb-positive US adults was 3.76% (95% CI 2.80–4.72%), which corresponds to 371,112 (95% CI 276,360–465,864) HBsAg-negative/HBcAb-positive American adults who had already developed cirrhosis. Among those, cirrhosis/advanced fibrosis in the HBsAb-negative (hepatitis B surface antibody) group (6.28%, 95% CI 4.10–8.45%) was significantly higher than in the HBsAb-positive group (3.08%, 95% CI 2.07–4.08%). Results were similar when APRI was used. Conclusion According to the FIB-4, 3.76% of HBsAg-negative and HBcAb-positive US adults had cirrhosis/advanced fibrosis, much higher than in the general population of the USA. Our data highlight the importance of cirrhosis screening in the HBsAg-negative/HBcAb-positive population to prevent advanced liver disease, especially in those who are HBsAb-negative. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-022-00680-2.

The dual role of regulatory T cells in hepatitis B virus infection and related hepatocellular carcinoma

“…In addition, there was no significant correlation between HBeAg and indeterminate phase (Figure 1a,b) [32]. A recent study reported that adults who are HBsAg‐negative/HBcAb‐positive can still develop cirrhosis or HCC [33].…”

Epidemiology of liver cirrhosis and associated complications: Current knowledge and future directions

“…Another study also analyzed NHANES data from 2017-2018 and found a 4.4% prevalence of suspected cirrhosis among patients with fatty liver disease[ 14 ]. A recent study utilizing NHANES data from 2001 to 2018 included 3115 HBsAg-negative/HBcAb-positive subjects in which the prevalence of cirrhosis/advanced liver fibrosis based on FIB-4 diagnosis was 3.76% (95%CI 2.80%-4.72%), notably higher than in the general US population[ 15 ]. A systematic review and meta-analysis summarized the prevalence of cirrhosis in HBV-infected populations in sub-Saharan Africa.…”

Effect of Anti-HBs on Mortality Among Resolved HBV Infection: a Population-Based Prospective Cohort Study

“…However, even if HBsAg loss is achieved, in some cases, HBV cannot be eradicated because of the persistence of covalently closed circular DNA (cccDNA) and HBV DNA integration. Thus, there is still a risk of HBsAg seroreversion, HBV reactivation, cirrhosis, and hepatocellular carcinoma [4][5][6]. Patients with resolved hepatitis B still have a significantly increased mortality compared with those without chronic liver disease [7].…”

“…Patients with resolved hepatitis B still have a significantly increased mortality compared with those without chronic liver disease [7]. Thus, surveillance should be continued after HBsAg loss [4][5][6]. Rigorous surveillance of the entire population of resolved HBV infections is neither necessary nor likely to be cost-effective.…”