HBsAg Level as Predictor of Liver Fibrosis in HBeAg Positive Patients With Chronic Hepatitis B Virus Infection

Abstract

Background and aims: Preliminary data suggests lower serum hepatitis B surface antigen level is associated with more severe liver fibrosis in HBeAg positive patients. We evaluated the association of HBsAg level with biochemical, virological, and histological features in asymptomatic patients with chronic HBV infection. Methods: HBsAg levels were measured at baseline in 481 asymptomatic, treatment naive patients with chronic HBV infection. Subjects were followed-up prospectively (median, 12; range, 8-36 months). Phases of HBV infection were defined after regular monitoring of HBV-DNA and transaminases. Liver histology was scored using the METAVIR system. Results: HBeAg positive (n, 126) patients were significantly younger than HBeAg negative (n, 355), median age 26 vs 30 years; P < 0.01. HBV genotype could be determined in 350 patients, 240 (68.57%) had genotype D and 100 (28.57%) had genotype A. HBsAg level had modest correlation with serum HBV DNA(r = 0.6 vs 0.4 in eAg positive & negative respectively). HBeAg + ve patients with fibrosis score ! F2 showed significantly lower median serum HBsAg levels and serum HBV DNA levels compared with patients with F0-F1 score (median, range; 4.51, 2.99-6.10 vs 5.06, 4.13-5.89, P < 0.01) and (8.39, 3.85-10.60, P < 0.01) respectively. Significant inverse correlation of HBsAg level was found with liver fibrosis in eAg positive group (r = À0.76; P < 0.001). HBsAg level cut off value 4.7 log 10 IU/ml predicted moderate to advance fibrosis (F ! 2) with 92% sensitivity, 85% specificity & 91% negative predictive value. Conclusion: Lower HBsAg level might reflect the status of advanced liver fibrosis in HBeAg positive chronic hepatitis B subjects. ( J CLIN EXP HEPATOL 2015;5:213-220)

Response-Guided Therapy Based on the Combination of Quantitative HBsAg and HBV DNA Kinetics in Chronic Hepatitis B Patients

“…Both HBV DNA and HBsAg levels have a declining evolution as long as liver disease progress from the immune-tolerant status to the active hepatitis and cirrhosis in HBeAg-positive patients [41]. Although previous studies showed that HBV DNA level could predict the risk of cirrhosis and HCC, it has been proved a poor correlation between HBsAg level and HBV DNA across different phases of the chronic HBV infection [8,41].…”

“…Although previous studies showed that HBV DNA level could predict the risk of cirrhosis and HCC, it has been proved a poor correlation between HBsAg level and HBV DNA across different phases of the chronic HBV infection [8,41]. Given that ALT measurement is a suboptimal marker for prediction of significant liver disease, it is recommended to have, as accurate as possible, an estimation of fibrosis and inflammation based on a reliable tool in order to decide antiviral treatment indication [42].…”

“…Based on these results, it has been suggested that HBeAg-positive patients with ALT ≤2×ULN and HBsAg ≥ 25,000 IU/mL could be followed without the need of liver biopsy [42]. On the other hand, there are evidences which support that lower serum levels of HBsAg are associated with more severe liver fibrosis in HBeAg-positive CHB patients [41]. A cutoff of 4.7 log 10 IU/mL predicted moderate to advanced fibrosis (F2-F4) in HBeAg-positive patients, with an accuracy of 89% and a NPV of 91% [41].…”

“…On the other hand, there are evidences which support that lower serum levels of HBsAg are associated with more severe liver fibrosis in HBeAg-positive CHB patients [41]. A cutoff of 4.7 log 10 IU/mL predicted moderate to advanced fibrosis (F2-F4) in HBeAg-positive patients, with an accuracy of 89% and a NPV of 91% [41]. Thus, a single-point baseline assessment of HBsAg level in HBeAg-positive chronic HBV-infected patients could become an accurate surrogate marker for distinguish moderate to advanced fibrosis from no or mild fibrosis [41].…”

“…A cutoff of 4.7 log 10 IU/mL predicted moderate to advanced fibrosis (F2-F4) in HBeAg-positive patients, with an accuracy of 89% and a NPV of 91% [41]. Thus, a single-point baseline assessment of HBsAg level in HBeAg-positive chronic HBV-infected patients could become an accurate surrogate marker for distinguish moderate to advanced fibrosis from no or mild fibrosis [41]. However, in HBeAg-negative patients, there were no reported significant differences in serum HBsAg levels between patients with moderate to severe fibrosis and those with no or mild fibrosis [41].…”