Background

Acute hepatitis B virus (aHBV) is thought to be self-limited with clearance of HBsAg within 6 months. There are limited reports of the presenting features and outcomes of adults with symptomatic aHBV in the U.S.

Patients and Methods

Demographics, clinical features and 12-month outcomes of patients with adjudicated aHBV were captured prospectively and compared to a contemporaneous cohort of chronic HBV (cHBV) cases enrolled in the Hepatitis B Research Network.

Results

Between 2011 and 2018, 60 adjudicated aHBV were compared to 1534 cHBV untreated controls. Although similar in age, other features were dissimilar: aHBV subjects were more often male (72% vs. 51%), single (72% vs. 30%), non-Hispanic whites or blacks (75% vs. 24%). They also were frequently genotype A₂ (65% vs. 9%) having different risk factors: sexual exposure (75% vs. 16%) or injection drug use (10% vs. 2%), compared to the cHBV controls. In addition to higher serum aminotransferase and bilirubin levels, acute cases had higher HBV DNA levels (4.8 vs. 3.6 log₁₀ IU/mL) while quantitative HBeAg levels were lower (1.4 vs. 3.0 log₁₀ IU/mL) despite higher rates of HBeAg (73% vs. 25%). The median time to HBsAg clearance was 27 weeks and to anti-HBs appearance, 41 weeks.

Conclusions

In the current era, Caucasian men infected with genotype A₂ as a result of sexual exposure or injection drug use were the predominant group in aHBV, suggesting a potential strategy for adult vaccination in North America. Strikingly, only an estimated 36% of subjects cleared HBsAg by month 6; the definition of resolution in acute hepatitis B may need to be modified. ClinicalTirals.gov number NCT01263587

中文翻译：

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北美成人急性乙型肝炎病毒感染

背景

急性乙型肝炎病毒 (aHBV) 被认为具有自限性，HBsAg 在 6 个月内清除。关于美国有症状的 aHBV 成人患者的表现特征和结果的报道有限

患者和方法

前瞻性地记录了已判定为 aHBV 的患者的人口统计学、临床特征和 12 个月的结果，并与乙型肝炎研究网络中登记的同期慢性 HBV (cHBV) 病例队列进行比较。

结果

2011 年至 2018 年间，对 60 例经判定的 aHBV 与 1534 例未经治疗的 cHBV 对照进行了比较。尽管年龄相似，但其他特征有所不同：aHBV 受试者更常见的是男性（72% vs. 51%）、单身（72% vs. 30%）、非西班牙裔白人或黑人（75% vs. 24%）。与 cHBV 对照相比，他们也经常是A _{2基因型（65% 对 9%），具有不同的危险因素：性接触（75% 对 16%）或注射毒品使用（10% 对 2%）。}除了较高的血清转氨酶和胆红素水平外，急性病例的 HBV DNA 水平较高（4.8 vs. 3.6 log ₁₀ IU/mL），而定量 HBeAg 水平较低（1.4 vs. 3.0 log 10 IU/mL _）IU/mL），尽管 HBeAg 发生率较高（73% 比 25%）。HBsAg 清除的中位时间为 27 周，抗 HBs 出现的中位时间为 41 周。

结论

在当今时代，由于性接触或注射吸毒而感染基因型 A _{2的白人男性是 aHBV 的主要群体，这表明北美成人疫苗接种的潜在策略。}引人注目的是，估计只有 36% 的受试者在第 6 个月时清除了 HBsAg；急性乙型肝炎消退的定义可能需要修改。ClinicalTirals.gov 编号 NCT01263587