Abstract
IntroductionThere is no data on the relationship between hepatitis B surface antigen (HBsAg) levels and liver fibrosis in hepatitis B e antigen (HBeAg)-positive patients with chronic hepatitis B (CHB).MethodsSerum HBsAg and HBV DNA levels in HBeAg-positive CHB patients with liver biopsies were analyzed. The upper limit of normal (ULN) of alanine aminotransferase (ALT) was 30 and 19 U/L for men and women respectively. Histologic assessment was based on Ishak fibrosis staging for fibrosis and Knodell histologic activity index (HAI) for necroinflammation.Results140 patients (65% male, median age 32.7 years) were recruited. 56 (40%) had ALT ≤2×ULN. 72 (51.4%) and 42 (30%) had fibrosis score ≤1 and necroinflammation grading ≤4 respectively. Patients with fibrosis score ≤1, when compared to patients with fibrosis score >1, had significantly higher median HBsAg levels (50,320 and 7,820 IU/mL respectively, p<0.001). Among patients with ALT ≤2×ULN, serum HBsAg levels achieved an area under receiver operating characteristic curve of 0.869 in predicting fibrosis score ≤1. HBsAg levels did not accurately predict necroinflammation score. HBsAg ≥25,000 IU/mL was independently associated with fibrosis score ≤1 (p = 0.025, odds ratio 9.042).Using this cut-off HBsAg level in patients with ALT ≤2×ULN, positive and negative predictive values for predicting fibrosis score ≤1 were 92.7% and 60.0% respectively. HBV DNA levels had no association with liver histology.ConclusionAmong HBeAg-positive patients with ALT ≤2×ULN, high serum HBsAg levels can accurately predict fibrosis score ≤1, and could potentially influence decisions concerning treatment commencement and reduce the need for liver biopsy.
Highlights
There is no data on the relationship between hepatitis B surface antigen (HBsAg) levels and liver fibrosis in hepatitis B e antigen (HBeAg)-positive patients with chronic hepatitis B (CHB)
The aim of our study was to evaluate the use of serum HBsAg levels in assessing liver histology in HBeAg-positive CHB patients
HBsAg staining patterns in liver histology [29] and antibody to the hepatitis B core antigen IgM titers [30] could assist in differentiating the two HBeAg-positive disease phases, the assessment of fibrosis remains an essential step in deciding treatment commencement [5]
Summary
There is no data on the relationship between hepatitis B surface antigen (HBsAg) levels and liver fibrosis in hepatitis B e antigen (HBeAg)-positive patients with chronic hepatitis B (CHB). Treatment guidelines by two international liver associations [3,4] recommend treatment commencement when serum alanine aminotransferase (ALT) is persistently .26upper limit of normal (ULN) in hepatitis B e antigen (HBeAg)-positive patients. Guidelines from another international liver association recommend treatment when there is clinical evidence of significant liver fibrosis e.g. by using liver biopsy in patients with elevated ALT [5]. A study from Asia involving 1105 potential liver donors has similar recommendations [11] Because of all these controversial issues, using ALT levels to classify patients for treatment initiation is suboptimal. Assessment of fibrosis is an important parameter in deciding treatment
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