What are the precursors of HBsAg clearance?

Generally, before the HBsAg (hepatitis B surface antigen) turns negative, there are often some indicative manifestations. These mainly include undetectable hepatitis B virus DNA, consistently normal liver function indicators, seroconversion from HBeAg (hepatitis B e antigen) positive to anti-HBe (hepatitis B e antibody) positive, reduced symptoms such as fatigue, and improvement in liver imaging studies. A detailed analysis is as follows:

1. Undetectable hepatitis B virus DNA: During HBV DNA testing, a negative result indicates weakened or halted viral replication. Effective suppression of viral replication is an important foundation for the subsequent possible loss of HBsAg, suggesting enhanced immune control over the virus.

2. Consistently normal liver function indicators: In liver function tests, indicators reflecting liver inflammation such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST) remain within normal ranges upon repeated testing. This indicates a significant reduction or resolution of liver inflammation, with liver cell damage being repaired, thus creating a favorable intrahepatic environment for HBsAg clearance.

3. HBeAg turning negative and anti-HBe turning positive: In the five-serum marker test for hepatitis B, the originally positive HBeAg gradually becomes negative, while anti-HBe changes from negative to positive—this is known as HBeAg seroconversion. This change suggests reduced viral replication activity and decreased infectivity, indicating a more stable disease status and serving as an important signal that HBsAg clearance may occur in the future.

4. Alleviation of symptoms such as fatigue: Previously existing symptoms such as fatigue, loss of appetite, and dull pain in the upper right abdomen gradually lessen or disappear. The improvement in general health indirectly reflects liver function recovery and suggests a diminishing impact of the virus on the body.

5. Improvement in liver imaging studies: Liver ultrasound, CT, and other imaging examinations show gradual improvement in previously existing abnormalities such as uneven liver echotexture, mild fatty infiltration, or signs of liver damage. The liver's morphology and structure become closer to normal, indicating controlled liver disease and providing favorable conditions for HBsAg clearance.

Patients are advised to undergo regular follow-up tests for hepatitis B-related markers, closely monitor disease progression, maintain a regular作息 (sleep-wake cycle), follow a balanced diet, avoid alcohol consumption and excessive fatigue, and support the body in maintaining a healthy condition.