Clinical Outcomes and Quantitative HBV Surface Antigen Levels in Diverse Chronic Hepatitis B Patients in Canada: A Retrospective Real-World Study of CHB in Canada (REVEAL-CANADA)
Carla S. Coffin,
Sarah Haylock-Jacobs,
Karen Doucette,
Alnoor Ramji,
Hin Hin Ko,
David K. Wong,
Magdy Elkhashab,
Robert Bailey,
Julia Uhanova,
Gerald Minuk,
Keith Tsoi,
Alexander Wong,
Mang M. Ma,
Edward Tam,
Mayur Brahmania,
Carmine Nudo,
Julie Zhu,
Christopher F. Lowe,
Carla Osiowy,
B. Cord Lethebe,
Stephen E. Congly,
Eric K. H. Chan,
Angelina Villasis-Keever,
Urbano Sbarigia,
Curtis L. Cooper,
Scott Fung
Affiliations
Carla S. Coffin
Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
Sarah Haylock-Jacobs
Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
Karen Doucette
Department of Medicine, University of Alberta, Edmonton, AB T6G 2R3, Canada
Alnoor Ramji
Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
Hin Hin Ko
Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
David K. Wong
Department of Medicine, University of Toronto, Toronto, ON M5G 2CV, Canada
Magdy Elkhashab
Toronto Liver Centre, Toronto, ON M6H 3M1, Canada
Robert Bailey
Bailey Health Clinic, Edmonton, AB T5H 4B9, Canada
Julia Uhanova
Department of Internal Medicine, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
Gerald Minuk
Department of Internal Medicine, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
Keith Tsoi
Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
Alexander Wong
Department of Medicine, University of Saskatchewan, Regina, SK S7N 5A2, Canada
Mang M. Ma
Department of Medicine, University of Alberta, Edmonton, AB T6G 2R3, Canada
Edward Tam
Pacific Gastroenterology Associates, Vancouver, BC V6Z 2K5, Canada
Mayur Brahmania
Multi Organ Transplant Unit, Department of Medicine, Division of Gastroenterology, Western University, London, ON N6A 3K7, Canada
Carmine Nudo
Cité-de-la-Santé de Laval, Laval, QC H7M 3L9, Canada
Julie Zhu
Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
Christopher F. Lowe
Division of Medical Microbiology, Providence Health Care, Vancouver, BC V6Z 1Y6, Canada
Carla Osiowy
National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB R3E 3R2, Canada
B. Cord Lethebe
Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
Stephen E. Congly
Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
Eric K. H. Chan
Janssen Global Services LC, Raritan, NJ 08869, USA
Angelina Villasis-Keever
Janssen Global Services LC, Raritan, NJ 08869, USA
Urbano Sbarigia
Janssen Pharmaceuticals NV, 2340 Beerse, Belgium
Curtis L. Cooper
Department of Medicine, Division of infectious Diseases, University of Ottawa, Ottawa, ON K1N 6N5, Canada
Scott Fung
Department of Medicine, University of Toronto, Toronto, ON M5G 2CV, Canada
Background: Hepatitis B surface antigen (HBsAg) loss is associated with improved clinical outcomes for individuals with chronic hepatitis B (CHB); however, the effects of varying HBsAg levels on clinical outcomes in diverse cohorts are understudied. Methods: In this cross-sectional, multicentre, retrospective study, the data on adult subjects enrolled in the Canadian HBV Network with CHB seen from 1 January 2012 to 30 January 2021 with the treatment and virologic data within 1 year of HBsAg testing were analyzed. Patients were tested for HBsAg using qualitative (for HBsAg-negative samples) and/or commercial quantitative assays. Fibrosis or hepatic necroinflammation was determined by the liver stiffness measurement (LSM). The baseline data were summarized using descriptive statistics and compared by using univariable/multivariable analyses. Results: This study included 844 CHB patients, with a median age of 49.6 years (IQR 40.1–60.5), and 37% were female. In total, 751 patients (78.6%) had known ethnicity data, and 76.7% self-reported as Asian, 11.4% as Black, 6.8% as White, and 4.8% as other. Among the 844 patients, 237 (28.0%) were HBsAg (−) (1000 IU/mL. Overall, 80% (682) had known HBeAg status at the last follow-up, and the majority (87.0%) were HBeAg-negative. In addition, 54% (461/844) had prior antiviral therapy, 19.7% of which (16.3, 23.7, n = 91) were HBsAg (−). The treated patients had a lower risk of cirrhosis (16.46, 95% CI 1.89–143.39, p = 0.01) or HCC (8.23, 95% CI 1.01–67.39, p = 0.05) than the untreated patients. A lower proportion of the HBsAg-loss group had cirrhosis (5.7% vs. 10.9%, p = 0.021) and HCC (0.9% vs. 6.2%, p = 0.001). Conclusion: In this retrospective, ethnically diverse cohort study, CHB patients who received antiviral therapy and/or had HBsAg loss were less likely to develop cirrhosis and HCC, confirming the results of the studies in less diverse cohorts. No association was found between the qHBsAg level and fibrosis determined with LSM. Individuals who achieved HBsAg loss had low-level qHBsAg within 1 year of seroclearance.
