Association between changes in HBsAb levels and hepatic adverse events after HBsAg clearance in non-cirrhotic chronic hepatitis B patients

OBJECTIVE: The relationship between changes in hepatitis B surface antibody (HBsAb) levels and hepatic adverse events after hepatitis B surface antigen (HBsAg) clearance remains unclear. This study aimed to investigate the correlation between HBsAb level changes and hepatic adverse events in non-cirrhotic patients following HBsAg clearance. METHODS: We retrospectively analyzed patients with HBsAg seroclearance achieved via pegylated interferon-alpha (Peg-IFNα) therapy in the Department of Hepatology II at Beijing Ditan Hospital, Capital Medical University, from October 2008 to December 2023. Participants were stratified by baseline HBsAb levels into negative (< 10 mIU/mL), low (10-100 mIU/mL), medium (100-1000 mIU/mL), and high (≥ 1000 mIU/mL) groups. Based on HBsAb trends during follow-up, patients were categorized into declining, stable, and rising groups. The primary endpoint was the incidence of hepatic adverse events after HBsAg clearance. RESULTS: A total of 390 patients were included, with a median age of 38 (32-44) years and a median follow-up of 53.50 (11.00-173.00) months. During follow-up, 4 cases of hepatic adverse events occurred, all in the declining group (4 cases, 3.05%), while none were observed in the stable or rising groups (P = 0.018). Changes in HBsAb levels were inversely correlated with the incidence of hepatic adverse events (rs = -0.125, P = 0.014). CONCLUSION: Declining HBsAb levels after HBsAg clearance may be associated with an increased risk of hepatic adverse events. CLINICAL TRIAL: This study was registered at ClinicalTrials.gov (ID: NCT04301908; registration date: 03/06/2020; https://register. CLINICALTRIALS: gov/ ).