HBsAg and anti-HBs coexistence in patients with HBV in acute and chronic phases

HBsAg and anti-HBs coexistence represents an unusual serological pattern in hepatitis B virus (HBV) infection. However, its natural course remains unclear. This study investigated the occurrence of this serological pattern in patients with HBV in acute and chronic phases and estimated the associated...

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Main Authors: Zhongshu Pu, Zhaohua Ji, Haixia Su, Ting Fu, Zhongjun Shao, Yongping Yan
Format: Article
Language:English
Published: Elsevier 2025-05-01
Series:Virus Research
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Online Access:http://www.sciencedirect.com/science/article/pii/S0168170225000449
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author Zhongshu Pu
Zhaohua Ji
Haixia Su
Ting Fu
Zhongjun Shao
Yongping Yan
author_facet Zhongshu Pu
Zhaohua Ji
Haixia Su
Ting Fu
Zhongjun Shao
Yongping Yan
author_sort Zhongshu Pu
collection DOAJ
description HBsAg and anti-HBs coexistence represents an unusual serological pattern in hepatitis B virus (HBV) infection. However, its natural course remains unclear. This study investigated the occurrence of this serological pattern in patients with HBV in acute and chronic phases and estimated the associated risks. Of the 215 adult patients diagnosed with acute-phase HBV, 19 (8.84 %) cases demonstrated HBsAg and anti-HBs coexistence. In the chronic phase, 54 new cases of HBsAg and anti-HBs coexistence were identified during a median follow-up of 14 months (interquartile range: 14–28) among 4593 HBsAg-positive patients. The average annual incidence of coexistence was 1.41 % ± 0.28 %. The cumulative risk of HBsAg and anti-HBs coexistence in chronic phase patients was higher in those aged ≥ 50 years (risk ratio [RR]: 1.79, 95 % confidence interval [CI]: 1.04–3.09, P = 0.035), with positive HBeAg (RR: 3.43, 95 % CI: 1.91–6.19, P < 0.001), baseline alanine transaminase abnormalities (RR: 3.62, 95 % CI: 1.93–6.79, P < 0.001), and higher HBV DNA levels (RR: 1.97, 95 % CI: 1.12–3.49, P = 0.017). The quasispecies heterogeneity of the “a” determinant mutation demonstrated no significant change during the occurrence of coexistence with HBsAg and anti-HBs in HBV infection. Therefore, HBsAg and anti-HBs coexistence may be the intermediate process in the natural history of HBV infection, unrelated to “a'' determinant mutation but associated with the disease phase.
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spelling doaj-art-07deece8d5114349a77fbb675657e7332025-08-20T03:10:29ZengElsevierVirus Research1872-74922025-05-0135519956710.1016/j.virusres.2025.199567HBsAg and anti-HBs coexistence in patients with HBV in acute and chronic phasesZhongshu Pu0Zhaohua Ji1Haixia Su2Ting Fu3Zhongjun Shao4Yongping Yan5Department of Epidemiology, School of Public Health, Air Force Medical University, Xi'an, PR China; Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Xi'an, PR ChinaDepartment of Epidemiology, School of Public Health, Air Force Medical University, Xi'an, PR China; Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Xi'an, PR ChinaDepartment of Epidemiology, School of Public Health, Air Force Medical University, Xi'an, PR China; Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Xi'an, PR ChinaDepartment of Epidemiology, School of Public Health, Air Force Medical University, Xi'an, PR China; Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Xi'an, PR ChinaDepartment of Epidemiology, School of Public Health, Air Force Medical University, Xi'an, PR China; Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Xi'an, PR China; Corresponding author at: Department of Epidemiology, Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Air Force Medical University, No.169 Changle West Road, Xincheng District, Xi'an, Shaanxi 710032, PR China.Department of Epidemiology, School of Public Health, Air Force Medical University, Xi'an, PR China; Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Xi'an, PR China; Corresponding author at: Department of Epidemiology, Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Air Force Medical University, No.169 Changle West Road, Xincheng District, Xi'an, Shaanxi 710032, PR China.HBsAg and anti-HBs coexistence represents an unusual serological pattern in hepatitis B virus (HBV) infection. However, its natural course remains unclear. This study investigated the occurrence of this serological pattern in patients with HBV in acute and chronic phases and estimated the associated risks. Of the 215 adult patients diagnosed with acute-phase HBV, 19 (8.84 %) cases demonstrated HBsAg and anti-HBs coexistence. In the chronic phase, 54 new cases of HBsAg and anti-HBs coexistence were identified during a median follow-up of 14 months (interquartile range: 14–28) among 4593 HBsAg-positive patients. The average annual incidence of coexistence was 1.41 % ± 0.28 %. The cumulative risk of HBsAg and anti-HBs coexistence in chronic phase patients was higher in those aged ≥ 50 years (risk ratio [RR]: 1.79, 95 % confidence interval [CI]: 1.04–3.09, P = 0.035), with positive HBeAg (RR: 3.43, 95 % CI: 1.91–6.19, P < 0.001), baseline alanine transaminase abnormalities (RR: 3.62, 95 % CI: 1.93–6.79, P < 0.001), and higher HBV DNA levels (RR: 1.97, 95 % CI: 1.12–3.49, P = 0.017). The quasispecies heterogeneity of the “a” determinant mutation demonstrated no significant change during the occurrence of coexistence with HBsAg and anti-HBs in HBV infection. Therefore, HBsAg and anti-HBs coexistence may be the intermediate process in the natural history of HBV infection, unrelated to “a'' determinant mutation but associated with the disease phase.http://www.sciencedirect.com/science/article/pii/S0168170225000449HBsAg and anti-HBs coexistenceOccurrenceRisk factorsNatural history
spellingShingle Zhongshu Pu
Zhaohua Ji
Haixia Su
Ting Fu
Zhongjun Shao
Yongping Yan
HBsAg and anti-HBs coexistence in patients with HBV in acute and chronic phases
Virus Research
HBsAg and anti-HBs coexistence
Occurrence
Risk factors
Natural history
title HBsAg and anti-HBs coexistence in patients with HBV in acute and chronic phases
title_full HBsAg and anti-HBs coexistence in patients with HBV in acute and chronic phases
title_fullStr HBsAg and anti-HBs coexistence in patients with HBV in acute and chronic phases
title_full_unstemmed HBsAg and anti-HBs coexistence in patients with HBV in acute and chronic phases
title_short HBsAg and anti-HBs coexistence in patients with HBV in acute and chronic phases
title_sort hbsag and anti hbs coexistence in patients with hbv in acute and chronic phases
topic HBsAg and anti-HBs coexistence
Occurrence
Risk factors
Natural history
url http://www.sciencedirect.com/science/article/pii/S0168170225000449
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