Association Between Seroclearance of Hepatitis B Surface Antigen and Long-term Clinical Outcomes of Patients With Chronic HBV Infection: Systematic Review and Meta-analysis.
Seroclearance of hepatitis B surface antigen (HBsAg) is the desired endpoint of treatment for chronic hepatitis B virus (HBV) infection, according to guidelines. We performed a systematic review and meta-analysis to evaluate the strength of association between HBsAg seroclearance and long-term clinical outcomes.We performed a systematic review of the PubMed, EMBASE, and Cochrane Library databases for articles that assessed HBsAg status and reported the incidence of hepatocellular carcinoma (HCC), liver decompensation, liver transplantation, and/or all-cause mortality during follow up. We performed a meta-analysis of rate ratios (RR) using a random effects model independently for each endpoint and for a composite endpoint.We analyzed data from 28 studies, comprising a total of 188,316 patients with chronic HBV infection (treated and untreated), and 1,486,081 person-years (P-Y) of follow up; 26 reported data on HCC, 7 on liver decompensation, and 13 on liver transplantation and/or death. The composite event rates were 0.19/1000 P-Y for the HBsAg seroclearance group and 2.45/1000 P-Y for the HBsAg-persistent group. Pooled RRs for the HBsAg seroclearance group were 0.28 for liver decompensation for liver decompensation (95% CI, 0.13-0.59; P=.001), 0.30 for HCC (95% CI, 0.20-0.44; P