Spontaneous HBsAg Loss and Seroconversion in Chronic HBV Patients Following Severe COVID-19: A Five-Year Follow-Up of Three Patients

Abstract

Spontaneous HBsAg loss is rare in untreated chronic hepatitis B (HBV) patients, with its triggers still largely unknown. This case study reports a five-year follow-up male, treatment-naïve, chronic mono infected HBV patients who experienced spontaneous HBsAg loss and seroconversion following severe COVID-19 infection.

Three HBV mono-infected patients, had been monitored since 2016, they were initially categorized to be in an inactive carriers state, exhibiting low serum HBsAg levels (<55 IU/ml) and HBV DNA (<100 IU/ml). All of them had normal aminotransferases and no liver cirrhosis by transient elastography. During 2020-2021, they showed significant increases in HBsAg (15,000-26,000 IU/ml) and HBV DNA (980-2,500 IU/ml) levels, alongside mild  to moderate elevations (80-115 IU/L) in aminotransferases (ALT, AST) GGT and bilirubin levels. In the follow up visits, all three patients’ demonstrated HBsAg loss followed by HBV seroconversion (Anti-HBs: 12-55 IU/ml).

The observed increases in aminotransferases, HBsAg and HBV DNA levels might suggest an immune-mediated flare, possibly linked to a cytotoxic T lymphocyte response against HBV. The coinciding severe COVID-19 infection may have played a critical role in triggering such immune responses. Further studies are needed to confirm the possible link between severe COVID-19 and spontaneous HBsAg loss among chronic treatment naïve HBV infected patients.