Metabolic syndrome delays HBeAg seroclearance in Chinese patients with hepatitis B

Summary Background Delayed hepatitis B e antigen ( HB eAg) seroclearance increases the risk of cirrhosis and hepatocellular carcinoma ( HCC ). The effect of metabolic syndrome (MetS) on HB eAg seroclearance in chronic hepatitis B ( CHB ) patients remains unclear. Aims To examine the effect of MetS on HB eAg seroclearance. Methods A prospective cohort of 413 treatment‐naïve HB eAg‐positive CHB patients from 2005 to 2012 was studied. Clinical, virological and histological parameters were evaluated. The patients were classified into three groups according to the metabolic characteristics; normal, pre‐MetS and MetS based on the International Diabetes Federation criteria. The primary outcome was age at HB eAg seroclearance. Results The overall HB eAg seroclearance rate was 11.4% per annum during 19 351 patient‐months of follow‐up with no difference in HB eAg seroclearance rates between 162 treatment‐free and 251 patients receiving nucleos(t)ide analogues. Patients with pre‐MetS and MetS were older when HB eAg seroclearance occurred (44 ± 12 and 53 ± 7 years, respectively) than the normal patients (37 ± 9 years, all P < 0.01). Patients with pre‐MetS and MetS had more advanced liver fibrosis (33.0% and 53.1%, respectively) than the normal patients (18.4%, all P < 0.05). By the age of 50, 59.3% of the metabolic normal patients, 42.1% of the pre‐MetS and 18.7% of the MetS patients had achieved HB eAg seroclearance (all P < 0.05, except P = 0.07 for pre‐MetS vs. MetS). In multivariate analysis, MetS and type II diabetes at baseline were predictors of delayed HB eAg seroclearance after adjusting for viral load, anti‐viral therapy and necroinflammatiom. Conclusion Chinese patients with chronic hepatitis B and with pre‐metabolic syndrome or metabolic syndrome have delayed HB eAg seroclearance.