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Kim HS, Kim JS, Kim JM, Han JW, Lee SK, Nam H, Sung PS, Kwon JH, Bae SH, Choi JY, Yoon SK, Jang JW. Differential HBV replicative markers and covalently closed circular DNA transcription in immune-active chronic hepatitis B with and without HBeAg. Liver Int 2024. [PMID: 39073214 DOI: 10.1111/liv.16032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 05/29/2024] [Accepted: 06/26/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND AND AIMS Molecular processes driving immune-active chronic hepatitis B (CHB) with and without hepatitis B e antigen (HBeAg) remain incompletely understood. This study aimed to investigate expression profiles of serum and intrahepatic HBV markers and replicative activity of HBV in CHB patients with or without HBeAg. METHODS This study recruited 111 untreated immune-active CHB (60 HBeAg-positive and 51 HBeAg-negative) patients and quantified intrahepatic covalently closed circular DNA (cccDNA), pre-genomic RNA (pgRNA), total HBV DNA (tDNA), and replicative intermediates as well as serum HBV markers (HBV DNA, hepatitis B surface antigen, hepatitis B core-related antigen). Correlations between HBV markers and clinico-virological factors influencing expression levels of HBV markers were analysed. RESULTS Levels of all serum markers and intrahepatic cccDNA/tDNA as well as cccDNA transcriptional activity and virion productivity were significantly reduced in HBeAg-negative patients compared to those in HBeAg-positive patients. Additionally, correlations between intrahepatic cccDNA/pgRNA and serum markers were impaired in HBeAg-negative individuals. Aminotransferase levels were positively correlated with cccDNA transcriptional activity in HBeAg-positive patients, but not in HBeAg-negative patients. Notably, among HBeAg-positive patients, there was a progressive decline in pgRNA level, transcriptional activity, and serum HBV markers as liver fibrosis advanced, which was not observed in HBeAg-negative patients. CONCLUSIONS HBeAg loss is correlated with diminished intrahepatic HBV reservoirs and cccDNA transcription, leading to decreased serum HBV marker levels. Circulating HBV markers are not reliable indicators of intrahepatic HBV replicative activity for HBeAg-negative patients. Our findings reveal distinct disease phenotypes between immune-active CHB with and without HBeAg, highlighting the need to establish optimal surrogate biomarkers that can accurately mirror intrahepatic viral activity to aid in decision-making for antiviral therapy for immune-active CHB.
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Affiliation(s)
- Hye Seon Kim
- The Catholic University Liver Research Center, Collage of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Biomedicine & Health Sciences, Graduate School, The Catholic University of Korea, Seoul, Republic of Korea
- Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Seoub Kim
- The Catholic University Liver Research Center, Collage of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Biomedicine & Health Sciences, Graduate School, The Catholic University of Korea, Seoul, Republic of Korea
- Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Min Kim
- The Catholic University Liver Research Center, Collage of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Biomedicine & Health Sciences, Graduate School, The Catholic University of Korea, Seoul, Republic of Korea
- Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Won Han
- The Catholic University Liver Research Center, Collage of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soon Kyu Lee
- The Catholic University Liver Research Center, Collage of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Heechul Nam
- The Catholic University Liver Research Center, Collage of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Pil Soo Sung
- The Catholic University Liver Research Center, Collage of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung Hyun Kwon
- The Catholic University Liver Research Center, Collage of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Si Hyun Bae
- The Catholic University Liver Research Center, Collage of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong Young Choi
- The Catholic University Liver Research Center, Collage of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Kew Yoon
- The Catholic University Liver Research Center, Collage of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeong Won Jang
- The Catholic University Liver Research Center, Collage of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Liu J, Yu Y, Zhao H, Guo L, Yang W, Yan Y, Lv J. Latest insights into the epidemiology, characteristics, and therapeutic strategies of chronic hepatitis B patients in indeterminate phase. Eur J Med Res 2024; 29:343. [PMID: 38902822 PMCID: PMC11191257 DOI: 10.1186/s40001-024-01942-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/17/2024] [Indexed: 06/22/2024] Open
Abstract
As a hepatotropic virus, hepatitis B virus (HBV) can establish a persistent chronic infection in the liver, termed, chronic hepatitis B (CHB), which causes a series of liver-related complications, including fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). HCC with HBV infection has a significantly increased morbidity and mortality, whereas it could be preventable. The current goal of antiviral therapy for HBV infection is to decrease CHB-related morbidity and mortality, and achieve sustained suppression of virus replication, which is known as a functional or immunological cure. The natural history of chronic HBV infection includes four immune phases: the immune-tolerant phase, immune-active phase, inactive phase, and reactivation phase. However, many CHB patients do not fit into any of these defined phases and are regarded as indeterminate. A large proportion of indeterminate patients are only treated with dynamic monitoring rather than recommended antiviral therapy, mainly due to the lack of definite guidelines. However, many of these patients may gradually have significant liver histopathological changes during disease progression. Recent studies have focused on the prevalence, progression, and carcinogenicity of indeterminate CHB, and more attention has been given to the prevention, detection, and treatment for these patients. Herein, we discuss the latest understanding of the epidemiology, clinical characteristics, and therapeutic strategies of indeterminate CHB, to provide avenues for the management of these patients.
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Affiliation(s)
- Junye Liu
- Department of Clinical Laboratory, Honghui Hospital, Xi'an Jiaotong University, Youyi Dong Road, Xi'an, 710054, China
| | - Yan Yu
- Department of Clinical Laboratory, Honghui Hospital, Xi'an Jiaotong University, Youyi Dong Road, Xi'an, 710054, China
| | - Heping Zhao
- Department of Clinical Laboratory, Honghui Hospital, Xi'an Jiaotong University, Youyi Dong Road, Xi'an, 710054, China
| | - Lei Guo
- Department of Spinal Surgery, Honghui Hospital, Xi'an Jiaotong University, Youyi Dong Road, Xi'an, 710054, China
| | - Wenjuan Yang
- Department of Clinical Laboratory, Honghui Hospital, Xi'an Jiaotong University, Youyi Dong Road, Xi'an, 710054, China
| | - Yuzhu Yan
- Department of Clinical Laboratory, Honghui Hospital, Xi'an Jiaotong University, Youyi Dong Road, Xi'an, 710054, China
| | - Jing Lv
- Department of Clinical Laboratory, Honghui Hospital, Xi'an Jiaotong University, Youyi Dong Road, Xi'an, 710054, China.
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Peña-Asensio J, Calvo-Sánchez H, Miquel-Plaza J, Sanz-de-Villalobos E, González-Praetorius A, Delgado-Fernandez A, Torralba M, Larrubia JR. HBsAg level defines different clinical phenotypes of HBeAg(-) chronic HBV infection related to HBV polymerase-specific CD8 + cell response quality. Front Immunol 2024; 15:1352929. [PMID: 38545116 PMCID: PMC10966405 DOI: 10.3389/fimmu.2024.1352929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/29/2024] [Indexed: 04/13/2024] Open
Abstract
Background HBe-antigen(Ag)-negative chronic hepatitis B virus (HBV) infection is characterized by little liver fibrosis progression and vigorous HBV-multispecific CD8+ T-cell response. Aims To assess whether HBsAg level could discriminate different HBeAg-negative chronic HBV infection subtypes with dissimilar quality of HBV-specific CD8+ T-cell response. Methods We recruited 63 HBeAg-negative chronic HBV infection patients in which indirect markers of liver inflammation/fibrosis, portal pressure, viral load (VL), and HBV-specific CD8+ cell effector function were correlated with HBsAg level. Results A positive linear trend between HBsAg level and APRI, liver stiffness (LS), liver transaminases, and HBV VL, and a negative correlation with platelet count were observed. Frequency of cases with HBV-specific CD8+ T-cell proliferation against at least two HBV epitopes was higher in HBsAg < 1,000 IU/ml group. CD8+ T-cell expansion after HBVpolymerase456-63-specific stimulation was impaired in HBsAg > 1,000 IU/ml group, while the response against HBVcore18-27 was preserved and response against envelope183-91 was nearly abolished, regardless of HBsAg level. Cases with preserved HBVpolymerase456-63 CD8+ cell response had lower LS/duration of infection and APRI/duration of infection rates. HBV-polymerase456-63-specific CD8+ T-cell proliferation intensity was negatively correlated with LS/years of infection ratio. Conclusion HBsAg > 1,000 IU/ml HBeAg-negative chronic HBV infection group shows indirect data of higher degree of inflammation, liver stiffness, and fibrosis progression speed, which are related to an impaired HBV-polymerase-specific CD8+ T-cell response.
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Affiliation(s)
- Julia Peña-Asensio
- Department of Biology of Systems, University of Alcalá, Alcalá de Henares, Spain
- Translational Research Group in Cellular Immunology, Instituto de Investigación Sanitaria de Castilla La-Mancha (IDISCAM), Toledo, Spain
| | - Henar Calvo-Sánchez
- Translational Research Group in Cellular Immunology, Instituto de Investigación Sanitaria de Castilla La-Mancha (IDISCAM), Toledo, Spain
- Section of Gastroenterology, Guadalajara University Hospital, Guadalajara, Spain
- Department of Medicine and Medical Specialties, University of Alcalá, Alcalá de Henares, Spain
| | - Joaquín Miquel-Plaza
- Translational Research Group in Cellular Immunology, Instituto de Investigación Sanitaria de Castilla La-Mancha (IDISCAM), Toledo, Spain
- Section of Gastroenterology, Guadalajara University Hospital, Guadalajara, Spain
| | - Eduardo Sanz-de-Villalobos
- Translational Research Group in Cellular Immunology, Instituto de Investigación Sanitaria de Castilla La-Mancha (IDISCAM), Toledo, Spain
- Section of Gastroenterology, Guadalajara University Hospital, Guadalajara, Spain
| | - Alejandro González-Praetorius
- Translational Research Group in Cellular Immunology, Instituto de Investigación Sanitaria de Castilla La-Mancha (IDISCAM), Toledo, Spain
- Section of Microbiology, Guadalajara University Hospital, Guadalajara, Spain
| | - Alberto Delgado-Fernandez
- Translational Research Group in Cellular Immunology, Instituto de Investigación Sanitaria de Castilla La-Mancha (IDISCAM), Toledo, Spain
| | - Miguel Torralba
- Translational Research Group in Cellular Immunology, Instituto de Investigación Sanitaria de Castilla La-Mancha (IDISCAM), Toledo, Spain
- Department of Medicine and Medical Specialties, University of Alcalá, Alcalá de Henares, Spain
- Service of Internal Medicine, Guadalajara University Hospital, Guadalajara, Spain
| | - Juan-Ramón Larrubia
- Translational Research Group in Cellular Immunology, Instituto de Investigación Sanitaria de Castilla La-Mancha (IDISCAM), Toledo, Spain
- Section of Gastroenterology, Guadalajara University Hospital, Guadalajara, Spain
- Department of Medicine and Medical Specialties, University of Alcalá, Alcalá de Henares, Spain
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Zhang Z, Lu W, Huang D, Zhou X, Ding R, Li X, Wang Y, Lin W, Zeng D, Feng Y. Capabilities of hepatitis B surface antigen are divergent from hepatitis B virus DNA in delimiting natural history phases of chronic hepatitis B virus infection. Front Immunol 2022; 13:944097. [PMID: 35958621 PMCID: PMC9359073 DOI: 10.3389/fimmu.2022.944097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveQuantitative hepatitis B surface antigen (HBsAg) and hepatitis B virus (HBV) DNA in the natural history of chronic HBV infection have not been rationally evaluated. This study aimed to re-characterize quantitative HBsAg and HBV DNA in the natural history phases.MethodsA total of 595 and 651 hepatitis B e antigen (HBeAg)-positive patients and 485 and 705 HBeAg-negative patients were assigned to the early and late cohorts, respectively. Based on the ‘S-shape’ receiver operating characteristic (ROC) curves, the HBeAg-positive sub-cohorts with possibly high HBV replication (PHVR) and possibly low HBV replication (PLVR) and the HBeAg-negative sub-cohorts with possibly high HBsAg expression (PHSE) and possibly low HBsAg expression (PLSE) were designated.ResultsThe areas under the ROC curve (AUCs) of HBsAg and HBV DNA in predicting HBeAg-positive significant hepatitis activity (SHA) in the early cohort, sub-cohort with PHVR, and sub-cohort with PLVR were 0.655 and 0.541, 0.720 and 0.606, and 0.553 and 0.725, respectively; those in the late cohort, sub-cohort with PHVR, and sub-cohort with PLVR were 0.646 and 0.501, 0.798 and 0.622, and 0.603 and 0.674, respectively. The AUCs of HBsAg and HBV DNA in predicting HBeAg-negative SHA in the early cohort, sub-cohort with PHSE, and sub-cohort with PLSE were 0.508 and 0.745, 0.573 and 0.780, and 0.577 and 0.729, respectively; those in the late cohort, sub-cohort with PHSE, and sub-cohort with PLSE were 0.503 and 0.761, 0.560 and 0.814, and 0.544 and 0.722, respectively. The sensitivity and specificity of HBsAg ≤4.602 log10 IU/ml in predicting HBeAg-positive SHA in the early cohort were 82.6% and 45.8%, respectively; those in the late cohort were 87.0% and 44.1%, respectively. The sensitivity and specificity of HBV DNA >3.301 log10 IU/ml in predicting HBeAg-negative SHA in the early cohort were 73.4% and 60.8%, respectively; those in the late cohort were 73.6% and 64.1%, respectively.ConclusionQuantitative HBsAg and HBV DNA are valuable, but their capabilities are divergent in delimiting the natural history phases.
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Affiliation(s)
- Zhanqing Zhang
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
- *Correspondence: Zhanqing Zhang,
| | - Wei Lu
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Dan Huang
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Xinlan Zhou
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Rongrong Ding
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Xiufen Li
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yanbing Wang
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Weijia Lin
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Dong Zeng
- Department of Clinical Pathology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yanling Feng
- Department of Clinical Pathology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
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Peña‐Asensio J, Calvo H, Miquel J, Sanz‐de‐Villalobos E, González‐Praetorius A, Torralba M, Larrubia J. Model to predict on-treatment restoration of functional HBV-specific CD8 + cell response foresees off-treatment HBV control in eAg-negative chronic hepatitis B. Aliment Pharmacol Ther 2022; 55:1545-1559. [PMID: 35224746 PMCID: PMC9305412 DOI: 10.1111/apt.16850] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/12/2022] [Accepted: 02/14/2022] [Indexed: 01/30/2023]
Abstract
BACKGROUND Hepatitis B virus (HBV)-specific CD8+ cell response restoration during nucleos(t)ide analogue (NUC) treatment could lead to off-treatment HBV control in e-antigen-negative chronic hepatitis B (CHBe(-)). AIM To predict this response with variables involved in T-cell exhaustion for use as a treatment stopping tool. METHODS In NUC-treated CHBe(-) patients, we considered a functional response in cases with HBV-specific CD8+ cells against core and polymerase HBV epitopes able to proliferate and secrete type I cytokines after antigen encounter. We performed a logistic regression model (LRM) to predict the likelihood of developing this response, based on patient age (subrogate of infection length), HBsAg level, NUC therapy starting point and duration (antigenic pressure). We discontinued treatment and assessed HBV DNA dynamics, HBsAg decline and loss during off-treatment follow-up according to LRM likelihood. RESULTS We developed an LRM that predicted the presence of a proliferative type I cytokine-secreting CD8+ cell response, which correlated positively with treatment duration and negatively with treatment initiation after the age of 40 years and with age adjusted by HBsAg level. We observed a positive correlation between LRM probability and intensity of proliferation, number of epitopes with the functional proliferating response and type I cytokine secretion level. Off-treatment, HBsAg loss, HBsAg decline >50% and HBV control were more frequent in the group with >90% LRM probability. CONCLUSIONS Short-term low-level antigen exposure and early long-term NUC treatment influence the restoration of a functional HBV-specific CD8+ cell response. Based on these predictors, a high likelihood of detecting this response at treatment withdrawal is associated with off-treatment HBV control and HBsAg decline and loss.
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Affiliation(s)
- Julia Peña‐Asensio
- Department of Biology of SystemsUniversity of AlcaláAlcalá de HenaresSpain
| | - Henar Calvo
- Section of GastroenterologyGuadalajara University HospitalGuadalajaraSpain
| | - Joaquín Miquel
- Section of GastroenterologyGuadalajara University HospitalGuadalajaraSpain
| | | | | | - Miguel Torralba
- Service of Internal MedicineGuadalajara University HospitalGuadalajaraSpain,Department of Medicine & Medical SpecialtiesUniversity of AlcaláAlcalá de HenaresSpain
| | - Juan‐Ramón Larrubia
- Section of GastroenterologyGuadalajara University HospitalGuadalajaraSpain,Department of Medicine & Medical SpecialtiesUniversity of AlcaláAlcalá de HenaresSpain
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Zhang ZQ, Shi BS, Lu W, Huang D, Wang YB, Feng YL. Quantitative serum HBV markers in predicting phases of natural history of chronic HBV infection. J Virol Methods 2021; 296:114226. [PMID: 34217779 DOI: 10.1016/j.jviromet.2021.114226] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/29/2021] [Accepted: 06/29/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Clinical importance of commercially available quantitative HBV markers has not been fully investigated. OBJECTIVE To choice and to evaluate clinically valuable HBV markers for predicting phases of natural history with chronic HBV infection. METHODS 472 naïve patients with chronic HBV infection were enrolled, in which 21 and 220 were confirmed as HBeAg-positive inactive and active hepatitis (EPIH and EPAH), respectively, and 106 and 125 were confirmed as HBeAg-negative inactive and active hepatitis (ENIH and ENAH), respectively. HBsAg, HBcrAg and anti- HBc were measured using chemiluminescent immunoassay, and HBV DNA was measured using PCR-fluorescence probing assay. RESULTS There were all statistical differences in medians of HBsAg, anti-HBc, HBcrAg and HBV DNA between EPIH and EPAH and between ENIH and ENAH (all P < 0.01). According to binary logistic stepwise regressions, HBsAg and anti-HBc were preferred variables for predicting EPAH, and HBcrAg and HBV DNA were preferred variables for predicting ENAH. Based on normalization for coefficients of preferred variables entering regression equations, a handy model of MEPAH for predicting EPAH and of MENAH for predicting ENAH was constructed, respectively. Area under receiver operating characteristic curves of MEPAH and MENAH for predicting EPAH and ENAH were 0.882 and 0.931, respectively. With standard of MEPAH ≤ 5.997 and MENAH > 10.535, sensitivity or specificity of which for predicting EPAH and ENAH were about 81.0 % and 87.0 %, respectively. CONCLUSION HBsAg and anti-HBc for predicting EPAH and HBcrAg and HBV DNA for predicting ENAH are dependable markers; MEPAH for predicting EPAH and MENAH for predicting ENAH have very good performance.
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Affiliation(s)
- Zhan-Qing Zhang
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center of Fudan University, China.
| | - Bi-Sheng Shi
- Scientific Research Center, Shanghai Public Health Clinical Center of Fudan University, China.
| | - Wei Lu
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center of Fudan University, China.
| | - Dan Huang
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center of Fudan University, China.
| | - Yan-Bing Wang
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center of Fudan University, China.
| | - Yan-Ling Feng
- Department of Clinical Pathology, Shanghai Public Health Clinical Center of Fudan University, China.
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Baklouti R, Gueddiche A, Ben Abdelwahed M, Aissaoui F, Zakhama M, Bouhlel W, Sriha A, Kooli I, Sallem OK, Argoubi A, Hichem LM, Ben Chaabane N, Safer L. The role of quantitative HBsAg in the natural history of e antigen-negative chronic hepatitis B: A Tunisian prospective study. Infect Dis Now 2020; 51:464-469. [PMID: 34366082 DOI: 10.1016/j.idnow.2020.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/06/2020] [Accepted: 10/29/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND/AIMS During the natural course of Chronic Hepatitis B (CHB) infection, differentiation between inactive carrier (IC) and HBeAg negative CHB is a subject of ongoing debate. We studied the role of hepatitis B surface antigen (HBsAg) level as a means of differentiating between CHB and IC in a group of untreated chronic HBeAg-negative HBV-infected patients. STUDY A total of 115 HBeAg negative carriers were enrolled and followed up for>12 months; 78 as inactive carriers (IC), and 37 as active carriers (AC). Among ACs, patients were categorized according to the highest rate of viral load: AC1 (n=23), active carriers with persistent HBV-DNA<20,000 IU/mL; AC2 (n=14), active carriers with HBV-DNA>20,000 IU/mL. RESULTS HBsAg levels were higher in AC compared to IC patients (1607 IU/ml vs. 225 IU/ml respectively, P=0.001). Among the AC group, the 23 AC1 cases had HBsAg levels significantly lower than the 14 AC2 patients (1756 IU/mL vs. 3327 IU/mL respectively; P<10-3). HBsAg showed weak correlation with HBV-DNA in the whole cohort (r=0.44, P<0.01). The suggested cutoff value of HBsAg titer to differentiate between the two groups was 938 IU/mL. Combined single-point quantification of HBsAg (938 IU/mL) and HBV DNA (2000 IU/mL) identified IC with 87.2% specificity and 91.7% positive predictive value. CONCLUSION This study confirms the predictability of a one-time combined HBsAg and HBV DNA measurement for true inactive carriers requiring neither strict follow-up nor antiviral treatment.
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Affiliation(s)
- Raoua Baklouti
- Faculty of medicine of Monastir, Department of gastroenterology, Fattouma Bourguiba Hospital, Monastir, Tunisia.
| | - Arwa Gueddiche
- Faculty of medicine of Monastir, Department of gastroenterology, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Mehdi Ben Abdelwahed
- Faculty of medicine of Monastir, Department of gastroenterology, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Firas Aissaoui
- Faculty of medicine of Monastir, Department of gastroenterology, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Majda Zakhama
- Faculty of medicine of Monastir, Department of gastroenterology, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Wided Bouhlel
- Faculty of medicine of Monastir, Department of gastroenterology, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Asma Sriha
- Faculty of medicine of Monastir, Department of community medicine, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Ikbel Kooli
- Faculty of medicine of Monastir, Department of infectiology, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Om Kalthoum Sallem
- Faculty of medicine of Monastir, Department of gastroenterology, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Aida Argoubi
- Faculty of medicine of Monastir, Department of virology, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Loghmeri Mohamed Hichem
- Faculty of medicine of Monastir, Department of gastroenterology, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Nabil Ben Chaabane
- Faculty of medicine of Monastir, Department of gastroenterology, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Leila Safer
- Faculty of medicine of Monastir, Department of gastroenterology, Fattouma Bourguiba Hospital, Monastir, Tunisia
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AST and HBeAg Level Can Help to Distinguish Non-Minimal Liver Inflammation in Persistently Normal Alanine Aminotransferase of Chronic HBV Infection. HEPATITIS MONTHLY 2020. [DOI: 10.5812/hepatmon.99580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Objectives: The current study aimed to investigate the characteristics of HBV serum markers (HBsAg, HBeAg), biochemical indicators, HBV DNA, and the age to distinguish minimal from non-minimal liver histological inflammation group in HBeAg-positive chronic HBV-infected patients with ALT≤ 1ULN (40U/L). Methods: The HBeAg-positive patients with treatment-naïve hospitalized at Ditan hospital from January 2008 to January 2017 are investigated. Patients were separated into two groups of minimal and non-minimal (mild and moderate) histological inflammation group by liver biopsy specimens. Data were analyzed using the SPSS package. Results: There were both positive (age, ALT, and AST) and negative correlation factors (serum HBsAg, HBeAg, or HBV DNA quantitation) to the liver inflammation grades. Multivariate regression analysis indicated that HBeAg (P < 0.001, b = -0.554, Exp (B) = 0.575) and AST (P = 0.003, b = 0.074, Exp (B) = 1.077) were independent influential factors. The cutoff values of HBeAg and AST were separately 2.85 Log10S/CO (AUC0.724, Sensitivity64%, Specificity79%), 28U/L (AUC0.726, Sensitivity68%, Specificity 78%) to distinguish Minimal from Non-minimal liver histological inflammation in chronic HBV-infected patients with ALT ≤ 1 ULN (40U/L). Conclusions: In total, 31.34% (115/367) of patients with chronic HBV infection who had non-minimal (mild and moderate) liver histological inflammation reached the required inflammation levels for antiviral treatment in HBeAg-positive patients with persistently normal ALT. HBeAg (cutoff < 2.85 Log10S/CO) and AST (cutoff > 28 U/L) were the independent influential factors of predicting non-minimal liver inflammation with ALT ≤ 1 ULN (40U/L).
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Analysis of pathological changes and related factors in liver tissue of HBeAg-negative patients with low HBsAg levels. Clin Exp Med 2020; 20:577-586. [PMID: 32656675 DOI: 10.1007/s10238-020-00645-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 07/04/2020] [Indexed: 10/23/2022]
Abstract
The relationship between pathological changes in liver tissue and the level of hepatitis B surface antigen (HBsAg) remains unclear. This study aimed to analyze the pathological changes in liver tissue and its related factors in patients with low-level HBsAg in order to provide a basis for judging the condition of these patients. A retrospective study was performed on 96 chronic hepatitis B patients with HBsAg levels < 1400 IU/ml and > 0.05 IU/ml. The histopathological examination of these patients was conducted. Univariate and multivariate analyses were used to determine risk factors for pathological changes. Among the 96 patients, 57.3% (55) had inflammatory events ≥ G2 and 33.4% (33) had fibrosis ≥ S2. HBV infection duration (p = 0.001) and splenic vein diameter (p = 0.001) were independent risk factors of liver inflammation (≥ G2) in patients with low-level HBsAg, while AST (p = 0.006) and PLT (p = 0.005) were independent risk factors of liver fibrosis (≥ S2). Moreover, HBV infection duration (p < 0.001) and spleen vein (p = 0.001) were independent factors of potential antiviral treatment. Liver inflammation and fibrosis are still common in patients with low-level HBsAg; thus, the monitoring and appropriate antiviral treatment cannot be ignored.
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10
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Lee HL, Jang JW, Han JW, Lee SW, Bae SH, Choi JY, Han NI, Yoon SK, Kim HJ, Lee S, Cho SG, Min CK, Kim DW, Lee JW. Early Hepatitis B Surface Antigen Seroclearance Following Antiviral Treatment in Patients with Reactivation of Resolved Hepatitis B. Dig Dis Sci 2019; 64:2992-3000. [PMID: 30982209 DOI: 10.1007/s10620-019-05614-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 04/04/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Long-term results on hepatitis B virus (HBV) reactivation in patients with resolved infection during anti-cancer therapy are unknown. This study investigated long-term risk and therapeutic endpoints including hepatitis B surface antigen (HBsAg) seroclearance following antiviral therapy in patients developing reactivation of resolved HBV. METHODS The study included 528 consecutive HBsAg-negative/hepatitis B core antibody-positive patients who underwent rituximab treatment or hematopoietic stem cell transplantation (HSCT) between 2006 and 2016. Long-term outcomes of patients with reactivation after antiviral therapy were examined in comparison with 37 HBsAg-positive chronic carriers under the same medical settings. RESULTS The 7-year cumulative rate of HBV reactivation was 10.8% and 57.9% in patients receiving rituximab treatment and HSCT, respectively. After antiviral initiation, patients with reactivation of resolved HBV showed significantly higher 1-year cumulative rates of hepatitis B e antigen seroconversion (69.2% vs. 22.6%, P = 0.008) and HBsAg seroclearance (61.8% vs. 3.3%, P < 0.001) than chronic HBsAg carriers. Reactivation of resolved HBV was independently predictive of HBsAg seroclearance in a combined group of reactivated patients and chronic HBsAg carriers. Low viral load at reactivation was predictive of HBsAg seroclearance in reactivated patients. The majority of patients with HBsAg seroclearance developed anti-HBs. None of the reactivated patients who achieved HBsAg seroclearance relapsed after cessation of antiviral therapy. CONCLUSIONS HBsAg seroclearance rapidly occurs following antiviral therapy for reactivation of resolved HBV infection, suggesting distinct clinical phenotypes as well as shorter duration of HBV infection associated with this particular disease setting-HBV reactivation.
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Affiliation(s)
- Hae Lim Lee
- Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeong Won Jang
- Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Ji Won Han
- Laboratory of Translational Immunology and Vaccinology, Graduate School of Medical Science and Engineering, KAIST, Daejeon, Republic of Korea
| | - Sung Won Lee
- Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Si Hyun Bae
- Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong Young Choi
- Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Nam Ik Han
- Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Kew Yoon
- Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hee-Je Kim
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seok Lee
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seok-Goo Cho
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang-Ki Min
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong-Wook Kim
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong Wook Lee
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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11
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El‐Raziky ME, Fouad HM, Abd Elkhalak NS, Ghobrial CM, El‐Karaksy HM. Paediatric chronic hepatitis B virus infection: are children too tolerant to treat? Acta Paediatr 2019; 108:1144-1150. [PMID: 30362178 DOI: 10.1111/apa.14626] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/27/2018] [Accepted: 10/23/2018] [Indexed: 12/22/2022]
Abstract
AIM Guidelines for managing the hepatitis B (HB) virus infection in children are still evolving. We aimed to assess the eligibility of children with HB virus infections for treatment based on the current guidelines. METHODS This observational study took place in 2016 and focused on children with isolated chronic HB infections, who attended the paediatric hepatology units at two centres in Egypt. We recruited all treatment-naïve children aged one year to 18 years who had completed at least 12 months of follow-up. RESULTS The study comprised 103 children aged between 1.5-18 years. Of these, 51 (50%) had the HB e antigen-positive chronic infection, 28 (27%) had the HB-negative chronic infection, 11 (11%) had the HB e antigen-positive chronic hepatitis and none had the HB e antigen-negative chronic hepatitis. The remaining 13 (12%) children did not fulfil the criteria for chronic HB definitions. Only two of the children were candidates for treatment: both had HB e antigen-positive chronic hepatitis and had undergone liver biopsies. CONCLUSION Only two of the 103 children with chronic HB were eligible for treatment according to the current guidelines and every measure should be taken to prevent the HB virus infection in children.
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Affiliation(s)
| | - Hanan Mina Fouad
- The Department of Paediatrics Faculty of Medicine, Helwan University Cairo Egypt
- The National Hepatology and Tropical Medicine Research Institute Cairo Egypt
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12
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Chen L, Shi J, Lu Z, Ye Y, Zhou X, Tan Y. Baseline HBsAg levels associated with HBsAg loss in HBeAg-negative chronic hepatitis B infection with persistently normal alanine aminotransferase. Clin Res Hepatol Gastroenterol 2019; 43:310-316. [PMID: 30528063 DOI: 10.1016/j.clinre.2018.10.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 10/19/2018] [Accepted: 10/25/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND We aimed to assess the long-term outcomes of e antigen-negative chronic hepatitis B (CHB) infection with low hepatitis B virus (HBV) DNA level (< 200 IU/mL) and persistently normal alanine aminotransferase (PNALT) and to explore the factors associated with the results. METHODS This retrospective cohort study enrolled consecutive baseline CHB patients with PNALT from January 2005 to June 2008. In total, 252 e antigen-negative CHB patients with PNALT and low HBV DNA level (< 200 IU/mL) were enrolled, of whom 188 were eligible for this analysis. Among the 188 patients, 131 were followed up more than twice per year and 57 were followed up at least once per year, with a median follow-up period of 102 (73-123) months. RESULTS Of 188 patients, 16 had HBV DNA level of > 200 IU/mL and PNALT, 164 had HBV DNA level of < 200 IU/mL and PNALT and 8 had HBV DNA level of > 200 IU/mL and elevated ALT level, of which 3 used an antiviral drug during follow-up. Twelve of 164 experienced HBsAg loss. Cox regression analysis suggested that baseline HBsAg levels were associated with HBsAg loss in patients after follow-up, especially the baseline HBsAg levels of < 200 IU⁄mL, which is a risk factor for HBsAg loss. The AUC of baseline HbsAg level in the e antigen-negative CHB group was 0.772 (cutoff value 426, P < 0.001). The cumulative probability of HBsAg loss in the HBsAg < 400 IU/L group was 20% (7/35), which ws higher than that in the HBsAg ≥ 400 IU/L group (3.88%; 5/129; X2 = 11.75, P = 0.0006). CONCLUSION The e antigen-negative CHB infection with low HBV DNA level (< 200 IU/mL) and PNALT will progress to chronic hepatitis, although the probability of its occurrence is low. Spontaneous HBsAg loss may not occur frequently because the manifested cumulative probability of HBsAg loss was higher in the HBsAg < 400 IU/L group than in the HBsAg ≥ 400 IU/L group.
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Affiliation(s)
- Li Chen
- Department of Hepatology, The Third Hospital of Zhenjiang Affiliated Jiangsu University, Zhenjiang, 212003, PR China.
| | - Junjie Shi
- Department of Hepatology, The Third Hospital of Zhenjiang Affiliated Jiangsu University, Zhenjiang, 212003, PR China
| | - Zhonghua Lu
- Department of Liver Disease, Wuxi No. 5 People's Hospital Affiliated to Jiangnan University, Wuxi, 214000, PR China
| | - Yun Ye
- Department of Hepatology, The Third Hospital of Zhenjiang Affiliated Jiangsu University, Zhenjiang, 212003, PR China
| | - Xinbei Zhou
- Department of Hepatology, The Third Hospital of Zhenjiang Affiliated Jiangsu University, Zhenjiang, 212003, PR China
| | - Youwen Tan
- Department of Hepatology, The Third Hospital of Zhenjiang Affiliated Jiangsu University, Zhenjiang, 212003, PR China.
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13
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Liu Y, Jiang M, Xue J, Yan H, Liang X. Serum HBV RNA quantification: useful for monitoring natural history of chronic hepatitis B infection. BMC Gastroenterol 2019; 19:53. [PMID: 30991954 PMCID: PMC6469196 DOI: 10.1186/s12876-019-0966-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 03/25/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND As an alternative biomarker of intrahepatic covalently closed circular DNA (cccDNA) transcriptional activity, hepatitis B virus (HBV) RNA may evolve during long-lasting virus-host interactions during chronic hepatitis B viral infection. The distribution pattern of serum HBV RNA levels in the natural course of chronic HBV infection remains unclear. The aim of this study was to evaluate the levels of HBV RNA during the natural course of CHB and the role in distinguishing the natural history of HBV infection. METHODS A total of 291 treatment-naïve chronic HBV carriers were enrolled. Based on the clinical, biochemical, serological, and histological data as well as HBV DNA levels, patients were classified into the following four categories: the immune-tolerant phase (IT,n = 35), HBeAg-positive immune-active phase (EPIA,n = 121), inactive chronic hepatitis B(ICH,n = 77) and HBeAg-negative immune reactive hepatitis (ENH,n = 58) [corrected]. The parameters and distribution patterns of serum HBV RNA were evaluated in relation to viral replication status, immune phase, disease category and Child-Pugh class. The relationships between serum HBV RNA and other serum hepatitis B viral markers were also analyzed. RESULTS Serum HBV RNA levels were significantly lower in the HBeAg-negative patients compared to those in the HBeAg-positive patients, with the lowest levels seen in inactive carriers. In HBeAg-negative patients, serum HBV RNA levels increased if there is reactivation to active hepatitis and showed obvious superiority for the combination of serum HBV DNA (cutoff>3.39 Log copies/mL) and HBsAg (cutoff>2.74 Log IU/mL) in discriminating between 'HBeAg-negative immune reactive' phase and inactive chronic hepatitis B phases of HBeAg-negative chronic HBV infection. Serum HBV RNA levels were positively correlated with serum HBV DNA and HBsAg levels in all chronic HBV-infected patients. A stratified analysis revealed that a correlation between serum HBV RNA and HBV DNA or HBsAg was present in HBeAg-positive patients; however, in HBeAg-negative patients, serum HBV RNA was positively correlated with HBV DNA only. CONCLUSION During the natural course of chronic HBV infection, serum HBV RNA levels vary. Serum HBV RNA can act as a biomarker to predict the natural history of disease in chronic hepatitis B patients. In treatment-naïve HBeAg-negative chronic HBV-infected individuals, serum HBV RNA shows superiority in differentiating the 'HBeAg-negative reactive' phase.
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Affiliation(s)
- Yayun Liu
- Department of Infectious Diseases, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433 China
| | - Meng Jiang
- Department of Infectious Diseases, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433 China
| | - Jianya Xue
- Department of Infectious Diseases, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433 China
| | - Hongli Yan
- Department of Reproductive Medicine Center, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433 China
| | - Xuesong Liang
- Department of Infectious Diseases, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433 China
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14
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Wang T, Cui D, Chen S, Xu X, Sun C, Dai Y, Cheng J. Analysis of clinical characteristics and S gene sequences in chronic asymptomatic HBV carriers with low-level HBsAg. Clin Res Hepatol Gastroenterol 2019; 43:179-189. [PMID: 30293895 DOI: 10.1016/j.clinre.2018.08.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/20/2018] [Accepted: 08/22/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND During the natural hepatitis B virus (HBV) infection process, some infected subjects are characterized by a sustained low serum HBV surface antigen (HBsAg) expression level. Most members in this population are chronic asymptomatic HBV carriers (ASCs). To elucidate the mechanism underlying low-level HBsAg expression in ASCs, we sequenced the HBV S gene in these patients to reveal specific sequence characteristics. METHODS Overall, 1308 cases of chronic ASCs were grouped according to their HBsAg serum expression levels (10 IU/mL). The clinical characteristics of the population were analysed in detail. The HBV S gene was sequenced from 276 ASC cases with low-level HBsAg expression. Additionally, 100 of 1032 ASC cases with high-level HBsAg expression were randomly selected for HBV S gene sequencing based on age matching according to the low-level HBsAg group. A comparative analysis was conducted with the HBV S gene sequences from ASCs with low HBsAg expression and the HBV reference S gene sequences from ASCs with high HBsAg expression. RESULTS The population with low-level HBsAg expression displayed the following primary clinical characteristics: mostly chronic asymptomatic HBV carriers, older age (mean age 55.09 years), HBsAg/anti-HBe/anti-HBc (core) positivity as the main serological pattern (97.1%), low HBV DNA replication (1.32 ± 1.60 log10 IU/mL), a low HBV-DNA positive rate (45.65%) and primarily genotype B (82.54%) and serotype adw (84.13%). The comparative analysis of the HBV S gene sequences from ASCs with low-level HBsAg showed significant mutations (including co-mutations) on both sides of the main hydrophilic region (MHR). CONCLUSION Significant mutations in multiple regions and at multiple sites (including co-mutations) on both sides of the MHR may be one cause of the low HBsAg expression level in this population.
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Affiliation(s)
- Tong Wang
- Faculty of Graduate Studies, Bengbu Medical College, Bengbu 233000, PR China; Department of Clinical Research, The 117th Hospital of PLA, Hangzhou 310013, PR China; Faculty of Graduate Studies, Jiangsu University, Zhenjiang 212013, PR China.
| | - Dawei Cui
- Department of Laboratory Medicine, Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, PR China; Faculty of Graduate Studies, Jiangsu University, Zhenjiang 212013, PR China.
| | - Shaoming Chen
- Department of Clinical Research, The 117th Hospital of PLA, Hangzhou 310013, PR China; Faculty of Graduate Studies, Jiangsu University, Zhenjiang 212013, PR China.
| | - Xujian Xu
- Department of Biotechnology, The University of Tokyo, Tokyo 1138656, Japan; Faculty of Graduate Studies, Jiangsu University, Zhenjiang 212013, PR China.
| | - Changgui Sun
- Department of Clinical Research, The 117th Hospital of PLA, Hangzhou 310013, PR China; Faculty of Graduate Studies, Jiangsu University, Zhenjiang 212013, PR China.
| | - Yuzhu Dai
- Department of Clinical Research, The 117th Hospital of PLA, Hangzhou 310013, PR China; Department of Laboratory Medicine, Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, PR China.
| | - Jun Cheng
- Department of Clinical Research, The 117th Hospital of PLA, Hangzhou 310013, PR China; Faculty of Graduate Studies, Jiangsu University, Zhenjiang 212013, PR China.
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15
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Pfefferkorn M, Böhm S, Schott T, Deichsel D, Bremer CM, Schröder K, Gerlich WH, Glebe D, Berg T, van Bömmel F. Quantification of large and middle proteins of hepatitis B virus surface antigen (HBsAg) as a novel tool for the identification of inactive HBV carriers. Gut 2018; 67:2045-2053. [PMID: 28951526 DOI: 10.1136/gutjnl-2017-313811] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 07/19/2017] [Accepted: 08/07/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Among individuals with chronic hepatitis B, those with hepatitis B e-antigen (HBeAg)-negative chronic hepatitis (CHB) can be difficult to distinguish from those with HBeAg-negative chronic HBV infection, also referred to as inactive HBV carriers (ICs), but both require different medical management. The level of HBV surface antigen (HBsAg) has been proposed as a marker to discriminate between chronic infection and hepatitis stages. HBsAg consists of large, middle and small HBs. The aim of this study was to determine whether the composition of HBsAg improved the identification of ICs among HBsAg-positive subjects with different phases of HBV infections. DESIGN HBV large surface proteins (LHBs) and HBV middle surface proteins (MHBs) were quantified in serum samples from 183 clinically well-characterised untreated patients with acute (n=14) HBV infection, ICs (n=44), CHBs (n=46), chronic HBeAg-positive phase (n=68) and hepatitis delta coinfection (n=11) using an ELISA, with well-defined monoclonal antibodies against the preS1 domain (LHBs) and the preS2-domain (MHBs). A Western blot analysis was used to verify the quantitation of the components of HBsAg. Total HBsAg was quantified using a modified commercially available assay (HBsAg V.6.0, Enzygnost, Siemens, Erlangen). RESULTS The composition of HBsAg showed specific patterns across different phases of hepatitis B. Individuals in the IC phase had significantly lower proportions of LHBs and MHBs than patients in acute or chronic phases irrespective of their HBV e-antigen status (p<0.0001) or HBsAg level. Both LHBs and MHBs ratios better predicted the IC phase than total HBsAg levels. CONCLUSION Quantification of MHBs, particularly LHBs represents a novel tool for the identification of the IC stage.
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Affiliation(s)
- Maria Pfefferkorn
- Section of Hepatology, Clinic for Gastroenterology and Rheumatology, University Hospital Leipzig, Leipzig, Germany
| | - Stephan Böhm
- Max von Pettenkofer-Institute for Hygiene and Clinical Microbiology, Ludwig-Maximilians-Universität, Munich, Germany
| | - Tina Schott
- Section of Hepatology, Clinic for Gastroenterology and Rheumatology, University Hospital Leipzig, Leipzig, Germany
| | - Danilo Deichsel
- Section of Hepatology, Clinic for Gastroenterology and Rheumatology, University Hospital Leipzig, Leipzig, Germany
| | - Corinna M Bremer
- National Reference Center for Hepatitis B and D Viruses, Institute for Medical Virology, German Centre for Infection Research (DZIF), Justus Liebig University Giessen, Giessen, Germany
| | - Kathrin Schröder
- National Reference Center for Hepatitis B and D Viruses, Institute for Medical Virology, German Centre for Infection Research (DZIF), Justus Liebig University Giessen, Giessen, Germany
| | - Wolfram H Gerlich
- National Reference Center for Hepatitis B and D Viruses, Institute for Medical Virology, German Centre for Infection Research (DZIF), Justus Liebig University Giessen, Giessen, Germany
| | - Dieter Glebe
- National Reference Center for Hepatitis B and D Viruses, Institute for Medical Virology, German Centre for Infection Research (DZIF), Justus Liebig University Giessen, Giessen, Germany
| | - Thomas Berg
- Section of Hepatology, Clinic for Gastroenterology and Rheumatology, University Hospital Leipzig, Leipzig, Germany
| | - Florian van Bömmel
- Section of Hepatology, Clinic for Gastroenterology and Rheumatology, University Hospital Leipzig, Leipzig, Germany
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16
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Zhang P, Du HB, Tong GD, Li XK, Sun XH, Chi XL, Xing YF, Zhou ZH, Li Q, Chen B, Wang H, Wang L, Jin H, Mao DW, Wang XB, Wu QK, Li FP, Hu XY, Lu BJ, Yang ZY, Zhang MX, Shi WB, He Q, Li Y, Jiang KP, Xue JD, Li XD, Jiang JM, Lu W, Tian GJ, Hu ZB, Guo JC, Li CZ, Deng X, Luo XL, Li FY, Zhang XW, Zheng YJ, Zhao G, Wang LC, Wu JH, Guo H, Mi YQ, Gong ZJ, Wang CB, Jiang F, Guo P, Yang XZ, Shi WQ, Yang HZ, Zhou Y, Sun NN, Jiao YT, Gao YQ, Zhou DQ, Ye YA. Serum hepatitis B surface antigen correlates with fibrosis and necroinflammation: A multicentre perspective in China. J Viral Hepat 2018; 25:1017-1025. [PMID: 29624802 DOI: 10.1111/jvh.12903] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 02/22/2018] [Indexed: 12/20/2022]
Abstract
The kinetics of serum hepatitis B surface antigen (HBsAg) during the natural history of hepatitis B virus (HBV) infection has been studied, but the factors affecting them remain unclear. We aimed to investigate the factors affecting HBsAg titres, using data from multicentre, large-sized clinical trials in China. The baseline data of 1795 patients in 3 multicentre trials were studied, and the patients were classified into 3 groups: hepatitis B early antigen (HBeAg)-positive chronic HBV infection (n = 588), HBeAg-positive chronic hepatitis B (n = 596), and HBeAg-negative chronic hepatitis B (n = 611). HBsAg titres in the different phases were compared, and multiple linear progression analyses were performed to investigate the implicated factors. HBsAg titres varied significantly in different phases (P = .000), with the highest (4.60 log10 IU/mL [10%-90% confidence interval: 3.52 log10 IU/mL-4.99 log10 IU/mL]) in patients with HBeAg-positive chronic HBV infection. In all phases, age and HBV DNA were correlated with serum HBsAg level. In HBeAg-positive chronic hepatitis B patients, a negative correlation between HBsAg titres and fibrosis stage was observed. Alanine amonitransferase or necroinflammatory activity was also correlated with HBsAg titres in HBeAg-negative chronic hepatitis B patients. In conclusion, decreased HBsAg titres may be associated with advancing fibrosis in HBeAg-positive chronic hepatitis B patients or increased necroinflammation in those with HBeAg-negative chronic hepatitis B. Our findings may help clinicians better understand the kinetics of HBsAg and provide useful insights into the management of this disease.
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Affiliation(s)
- P Zhang
- Department of Gastroenterology and Hepatology, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, China.,Institute of liver disease, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, China
| | - H B Du
- Department of Gastroenterology and Hepatology, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, China.,Institute of liver disease, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, China
| | - G D Tong
- Department of Hepatology, Shenzhen Hospital of Traditional Chinese Medicine, Shenzhen, Guangdong Province, China
| | - X K Li
- Department of Gastroenterology and Hepatology, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, China.,Institute of liver disease, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, China
| | - X H Sun
- Department of Hepatology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - X L Chi
- Department of Hepatology, Guangdong Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Y F Xing
- Department of Hepatology, Shenzhen Hospital of Traditional Chinese Medicine, Shenzhen, Guangdong Province, China
| | - Z H Zhou
- Department of Hepatology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Q Li
- The Fourth Ward, Fuzhou Infectious Disease Hospital, Fuzhou, Fujian Province, China
| | - B Chen
- Department of Hepatology, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan Province, China
| | - H Wang
- Department of Infectious Disease, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - L Wang
- Department of Hepatology, Chengdu Infectious Disease Hospital, Chengdu, Sichuan Province, China
| | - H Jin
- Department of Integrated Traditional and Western Medicine on Liver Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - D W Mao
- Department of Hepatology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi Province, China
| | - X B Wang
- Department of Integrated Traditional and Western Medicine on Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Q K Wu
- The First Department of Hepatology, Shenzhen No. 3 People's Hospital, Shenzhen, Guangdong Province, China
| | - F P Li
- Department of Hepatology, Shanxi Hospital of Traditional Chinese Medicine, Xi'an, Shanxi Province, China
| | - X Y Hu
- Department of Infectious Disease, The Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - B J Lu
- Department of Hepatology, The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, Liaoning Province, China
| | - Z Y Yang
- Department of Integrated Traditional and Western Medicine on Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - M X Zhang
- Department of Integrated Traditional and Western Medicine on Liver Diseases, Shenyang Infectious Disease Hospital, Shenyang, Liaoning Province, China
| | - W B Shi
- Department of Infectious Disease, The First Affiliated Hospital of Anhui Academy of Chinese Medicine, Hefei, Anhui Province, China
| | - Q He
- The First Department of Hepatology, Shenzhen No. 3 People's Hospital, Shenzhen, Guangdong Province, China
| | - Y Li
- Department of Hepatology, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
| | - K P Jiang
- Department of Hepatology, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong Province, China
| | - J D Xue
- Department of Hepatology, Shanxi Hospital of Traditional Chinese Medicine, Xi'an, Shanxi Province, China
| | - X D Li
- Department of Hepatology, Hubei Province Hospital of Traditional Chinese Medicine, Wuhan, Hubei Province, China
| | - J M Jiang
- Department of Hepatology, Guangdong Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong Province, China
| | - W Lu
- Department of Infectious Disease, Tianjin Infectious Disease Hospital, Tianjin, China
| | - G J Tian
- Department of Hepatology, Guangdong Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Z B Hu
- Department of Hepatology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi Province, China
| | - J C Guo
- Department of Hepatology, Hangzhou No. 6 People's Hospital, Hangzhou, Zhejiang Province, China
| | - C Z Li
- Department of Infectious Disease, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - X Deng
- Department of Hepatology, Ruikang Hospital, Guangxi University of Chinese Medicine, Nanning, Guangxi Province, China
| | - X L Luo
- Department of Hepatology, Hubei Province Hospital of Traditional Chinese Medicine, Wuhan, Hubei Province, China
| | - F Y Li
- Treatment and Research Center of Infectious Disease, 302 Military Hospital of China, Beijing, China
| | - X W Zhang
- Treatment and Research Center of Infectious Disease, 302 Military Hospital of China, Beijing, China
| | - Y J Zheng
- Department of Hepatology, Shenzhen Hospital of Traditional Chinese Medicine, Shenzhen, Guangdong Province, China
| | - G Zhao
- Department of Hepatology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - L C Wang
- Center of Infectious Disease, Huaxi Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - J H Wu
- Center of Hepatology, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, Fujian Province, China
| | - H Guo
- Department of Hepatology, The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Y Q Mi
- Department of Infectious Disease, Tianjin Infectious Disease Hospital, Tianjin, China
| | - Z J Gong
- Department of Infectious Disease, Hubei People's Hospital, Wuhan, Hubei Province, China
| | - C B Wang
- The Fourth Department of Infectious Disease, Linyi People's Hospital, Linyi, Shandong Province, China
| | - F Jiang
- Department of Gastroenterology and Hepatology, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, China.,Institute of liver disease, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, China
| | - P Guo
- Department of Hepatology, Xiyuan Hospital, China Academy of Chinese medical Science, Beijing, China
| | - X Z Yang
- Institute of liver disease, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, China.,Department of Infectious Disease, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, China
| | - W Q Shi
- Department of Hepatology, Xinhua Hospital, Zhejiang University of Traditional Chinese medicine, Hangzhou, Zhejiang Province, China
| | - H Z Yang
- Department of Traditional Chinese medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Y Zhou
- Department of Hepatology, Qingdao No. 6 People's Hospital, Qingdao, Shandong Province, China
| | - N N Sun
- Department of Hepatology, Beijing Hospital of Traditional Chinese Medicine, Beijing, China
| | - Y T Jiao
- Shunyi Hospital of Traditional Chinese Medicine, Beijing, China
| | - Y Q Gao
- Department of Hepatology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - D Q Zhou
- Department of Hepatology, Shenzhen Hospital of Traditional Chinese Medicine, Shenzhen, Guangdong Province, China
| | - Y A Ye
- Department of Gastroenterology and Hepatology, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, China.,Institute of liver disease, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, China
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17
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Zhang L, Li MH, Cao WH, Qi TL, Lu Y, Wu SL, Hao HX, Shen G, Liu RY, Hu LP, Chang M, Hua WH, Song SJ, Wan G, Xie Y. Negative Correlation of Serum Hepatitis B Surface Antigen and Hepatitis B e Antigen Levels with the Severity of Liver Inflammation in Treatment-naïve Patients with Chronic Hepatitis B Virus Infection. Chin Med J (Engl) 2018; 130:2697-2702. [PMID: 29133758 PMCID: PMC5695055 DOI: 10.4103/0366-6999.218000] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: Estimating the grades of liver inflammation is critical in the determination of antiviral therapy in patients chronically infected with hepatitis B virus (HBV). The aim of this study was to investigate the correlation of serum levels of hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) with the liver inflammation grades in treatment-naïve patients with chronic HBV infection. Methods: We retrospectively enrolled 584 treatment-naïve HBeAg-positive patients who underwent liver biopsy in Ditan Hospital from January 2008 to January 2016. Based on the severity of liver inflammation, the patients were divided into minimal, mild, and moderate groups. SPSS software was used for statistical analysis of all relevant data. Results: The liver histological examinations showed that 324, 194, and 66 patients had minimal, mild, and moderate liver inflammation, respectively. The median age of the three groups was 30, 33, and 38 years, respectively (χ2 = 26.00, P < 0.001). The median HBsAg levels in minimal, mild, and moderate inflammation groups were 4.40, 4.16, and 3.67 log U/ml, respectively, and the median HBeAg levels in the three groups were 3.12, 2.99, and 1.86 log sample/cutoff, respectively; both antigens tended to decrease as the grade of inflammation increased (χ2 = 99.68 and χ2 = 99.23, respectively; both P < 0.001). The cutoff values of receiver operating characteristic curve in the age, HBsAg and HBeAg levels were 36 years, 4.31 log U/ml, and 2.86 log S/CO, respectively, l to distinguish minimal grade and other grades of treatment-naïve HBeAg-positive patients with chronic HBV infection. Conclusions: Serum HBsAg and HBeAg quantitation might gradually decrease with aggravated liver inflammation and the corresponding cutoff values might help us to distinguish minimal grades and other grades and detect those who do not need antiviral therapy in treatment-naïve HBeAg-positive patients with chronic HBV infection.
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Affiliation(s)
- Lu Zhang
- Liver Diseases Center, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Ming-Hui Li
- Liver Diseases Center, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Wei-Hua Cao
- Liver Diseases Center, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Tian-Lin Qi
- Liver Diseases Center, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Yao Lu
- Liver Diseases Center, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Shu-Ling Wu
- Liver Diseases Center, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Hong-Xiao Hao
- Liver Diseases Center, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Ge Shen
- Liver Diseases Center, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Ru-Yu Liu
- Liver Diseases Center, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Lei-Ping Hu
- Liver Diseases Center, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Min Chang
- Liver Diseases Center, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Wen-Hao Hua
- Clinical Test Center, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Shu-Jing Song
- Clinical Test Center, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Gang Wan
- Liver Diseases Center, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Yao Xie
- Liver Diseases Center, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
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18
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Zhong GC, Wu YL, Hao FB, Rao XW, Yuan XW, Zhao Y, Gong JP. Current but not past hepatitis B virus infection is associated with a decreased risk of nonalcoholic fatty liver disease in the Chinese population: A case-control study with propensity score analysis. J Viral Hepat 2018; 25:842-852. [PMID: 29406564 DOI: 10.1111/jvh.12878] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 01/04/2018] [Indexed: 12/11/2022]
Abstract
The relation between hepatitis B virus (HBV) infection and fatty liver has been addressed by several observational studies, but their results remain controversial. To date, no study has precisely investigated the association of current and past HBV infection with the risk of nonalcoholic fatty liver disease (NAFLD) in the Chinese population. Therefore, we conducted a hospital-based case-control study in southwestern China to clarify this issue. A total of 631 newly ultrasound-diagnosed NAFLD cases and 2357 controls were selected from 123 243 consecutive patients admitted to a tertiary-care hospital between January 2015 and December 2016. Multivariate logistic regression was employed to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). A propensity score was developed for adjustment and matching. Subgroup analysis was conducted to identify potential effect modifiers. Current and past HBV infection had an overall prevalence of 9.7% and 55.2%, respectively. In the fully adjusted model, current HBV infection was associated with a decreased risk of NAFLD (OR 0.64; 95% CI 0.42-0.95). A similar inverse association was observed in both propensity-score-adjusted (OR 0.58; 95% CI 0.40-0.86) and propensity-score-matched analyses (OR 0.61; 95% CI 0.40-0.92).The inverse association was stronger in patients with hypertension than in those without (Pinteraction = .018).No significant association between past HBV infection and NAFLD risk was found. In conclusion, current but not past HBV infection is associated with a decreased risk of NAFLD in the Chinese population. The corresponding biological mechanisms remain to be elucidated.
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Affiliation(s)
- G C Zhong
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Y L Wu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - F B Hao
- Department of Pediatric Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - X W Rao
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - X W Yuan
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Y Zhao
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - J P Gong
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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19
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Broquetas T, Garcia-Retortillo M, Hernandez JJ, Puigvehí M, Cañete N, Coll S, Cabrero B, Giménez MD, Solà R, Carrión JA. Quantification of HBsAg to predict low levels and seroclearance in HBeAg-negative patients receiving nucleos(t)ide analogues. PLoS One 2017; 12:e0188303. [PMID: 29190670 PMCID: PMC5708657 DOI: 10.1371/journal.pone.0188303] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 11/04/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND HBeAg-negative chronic hepatitis B patients require long-term nucleos(t)ide analogues(NAs) because loss of surface antigen (HBsAg) is unusual. Low quantitative HBsAg (qHBsAg) levels can identify patients with higher probability of seroclearance. The aim of our study was to evaluate qHBsAg in HBeAg-negative patients receiving NAs to predict a reduction of HBsAg levels and seroclearance. METHODS Retrospective analysis of qHBsAg in HBeAg-negative patients before and at years 1, 3, 5, 8 and over of NAs treatment. RESULTS From 1999 to 2015, HBsAg was quantified in 358 serum samples from 95 HBeAg-negative patients. Low qHBsAg (<120 IU/mL) was identified at baseline or during follow-up in 14% of patients and HBsAg loss in 4%. No baseline variables predicted seroclearance and only treatment duration predicted low qHBsAg. The annual decline of qHBsAg was -0.102 log IU/mL and the median time to HBsAg loss was 6.04 years. The decline was greater in patients achieving low HBsAg levels (-0.257) than in those who did not (-0.057)(p<0.001). The diagnostic accuracy (ROC curve, 95%CI) of qHBsAg delta at year 3 was 0.89 (0.81-0.97), with cut-off >0.3 log IU/mL showing a positive and negative predictive value of 42% and 100% to identify patients achieving low levels of HBsAg. CONCLUSIONS Reduction of qHBsAg is slow in HBeAg-negative patients receiving NAs, although low levels or faster qHBsAg decline may occur in 14%. A qHBsAg reduction >0.3 log IU/mL at year 3 can identify patients with a higher probability of achieving low levels and HBsAg seroclearance.
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Affiliation(s)
- Teresa Broquetas
- Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona, Departament de Medicina, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Montserrat Garcia-Retortillo
- Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona, Departament de Medicina, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Juan José Hernandez
- Laboratori de Referencia de Catalunya (LRC), El Prat de Llobregat, Barcelona, Spain
| | - Marc Puigvehí
- Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona, Departament de Medicina, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Nuria Cañete
- Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona, Departament de Medicina, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Susana Coll
- Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona, Departament de Medicina, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Beatriz Cabrero
- Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona, Departament de Medicina, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Maria Dolors Giménez
- Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona, Departament de Medicina, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Ricard Solà
- Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona, Departament de Medicina, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - José A. Carrión
- Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona, Departament de Medicina, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
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20
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C-reactive protein-to-albumin ratio is a predictor of hepatitis B virus related decompensated cirrhosis: time-dependent receiver operating characteristics and decision curve analysis. Eur J Gastroenterol Hepatol 2017; 29:472-480. [PMID: 27984322 DOI: 10.1097/meg.0000000000000807] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Hepatitis B virus (HBV) infection remains a major health problem and HBV-related-decompensated cirrhosis (HBV-DC) usually leads to a poor prognosis. Our aim was to determine the utility of inflammatory biomarkers in predicting mortality of HBV-DC. MATERIALS AND METHODS A total of 329 HBV-DC patients were enrolled. Survival estimates for the entire study population were generated using the Kaplan-Meier method. The prognostic values for model for end-stage liver disease (MELD) score, Child-Pugh score, and inflammatory biomarkers neutrophil/lymphocyte ratio, C-reactive protein-to-albumin ratio (CAR), and lymphocyte-to-monocyte ratio (LMR) for HBV-DC were compared using time-dependent receiver operating characteristic curves and time-dependent decision curves. RESULTS The survival time was 23.1±15.8 months. Multivariate analysis identified age, CAR, LMR, and platelet count as prognostic independent risk factors. Kaplan-Meier analysis indicated that CAR of at least 1.0 (hazard ratio, 7.19; 95% confidence interval, 4.69-11.03), and LMR less than 1.9 (hazard ratio, 2.40; 95% confidence interval, 1.69-3.41) were independently associated with mortality of HBV-DC. The time-dependent receiver operating characteristic indicated that CAR showed the best performance in predicting mortality of HBV-DC compared with LMR, MELD score, and Child-Pugh score. The results were also confirmed by time-dependent decision curves. CONCLUSION CAR and LMR were associated with the prognosis of HBV-DC. CAR was superior to LMR, MELD score, and Child-Pugh score in HBV-DC mortality prediction.
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21
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Larsson SB, Malmström S, Hannoun C, Norkrans G, Lindh M. Mechanisms downstream of reverse transcription reduce serum levels of HBV DNA but not of HBsAg in chronic hepatitis B virus infection. Virol J 2015; 12:213. [PMID: 26645241 PMCID: PMC4673857 DOI: 10.1186/s12985-015-0447-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 12/03/2015] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Hepatitis B virus (HBV) DNA in serum of chronically infected patients declines by 3-4 log10 units at loss of HBe antigen (HBeAg) from serum. The mechanisms behind this decline, and the much smaller decline of surface antigen (HBsAg) levels, are still not well known. The aim of this study was to get a better understanding of this process by analysing both serum and intrahepatic markers of HBV replication. METHODS Levels of HBV DNA and HBsAg in serum, and covalently closed circular DNA (cccDNA), pregenomic RNA (pgRNA) and S-RNA and total intrahepatic HBV DNA (ihDNA) in liver biopsies from 84 chronically infected patients (16 positive and 68 negative for HBeAg) were analysed. RESULTS Lower HBV DNA levels within HBeAg-positive stage reflected lower levels of cccDNA and pgRNA with strong correlation. In HBeAg-negative patients, ihDNA levels were greater and HBV DNA levels in serum lower than expected from pgRNA levels. A lower HBV DNA/HBsAg ratio corresponded with lower pgRNA/cccDNA (p < 0.01) and higher S-RNA/cccDNA (p < 0.0001) ratios, suggesting that in HBeAg-negative patients transcription of pgRNA, but not of S-RNA, becomes suppressed. CONCLUSIONS The marked reduction of HBV DNA in serum after loss of HBeAg appears to be due to combined reduction of cccDNA, pgRNA and yet unidentified mechanisms downstream of reverse transcription. Such mechanisms include faster clearance of circulating virus or blocked secretion of virions, the latter supported by the observed relative increase of ihDNA in HBeAg-negative patients. The smaller reduction of S-RNA than of pgRNA partly explains why HBsAg remain high in the HBeAg-negative stage, supporting the possibility of HBsAg synthesis from integrated HBV DNA.
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Affiliation(s)
- Simon B Larsson
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Sebastian Malmström
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Charles Hannoun
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Gunnar Norkrans
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Magnus Lindh
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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22
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The usefulness of C-reactive protein and neutrophil-to-lymphocyte ratio for predicting the outcome in hospitalized patients with liver cirrhosis. BMC Gastroenterol 2015; 15:146. [PMID: 26498833 PMCID: PMC4619077 DOI: 10.1186/s12876-015-0378-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 10/15/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The role of clinical parameters such as systemic inflammatory response syndrome (SIRS) criteria in predicting the infection remains unclear in cirrhosis patients. The aim was to evaluate the usefulness of inflammatory markers including C-reactive protein (CRP) and the neutrophil-to-lymphocyte ratio (NLR) for diagnosis of infection and predicting the outcomes in hospitalized cirrhotic patients. METHODS The study included 184 cirrhotic patients consecutively hospitalized from 2011 to 2012. The presence of overt infection and survival was evaluated. CRP concentration, NLR, Model for End-Stage Liver Disease (MELD) score and the presence of SIRS were assessed. RESULTS The main cause of admission was uncontrolled ascites (36.4 %), followed by varix bleeding (23.9 %), and hepatic encephalopathy (13.6 %). Fifty-eight patients (31.5 %) had overt infection during hospitalization and thirty-two patients (17.4 %) expired during the follow up period (median 38 months). Ninety-two patients (52.2 %) fulfilled the SIRS criteria and among them, only 32 patients (38.5 %) had the overt infection. For diagnose of the infection, baseline CRP concentration was a significant factor compared to the presence of SIRS (odds ratio 1.202, P = 0.003). For predicting one-month short-term survival, MELD score, NLR and WBC count were significant factors but in Child-Pugh class C patients, NLR was only an independent factor. CONCLUSIONS CRP was a significant indicator of infection in hospitalized cirrhotic patients and a NLR was a useful predictor of 1-month survival, particularly in Child-Pugh class C patients. This study suggests that the inflammatory markers such as CRP and NLR can help identify cirrhotic patients at risk of unfavorable outcomes.
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23
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Karagoz E, Tanoglu A. Clinical importance of serum hepatitis B surface antigen quantification in the natural history of chronic hepatitis B infection. Kaohsiung J Med Sci 2015; 31:384-5. [DOI: 10.1016/j.kjms.2015.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 03/16/2015] [Accepted: 04/08/2015] [Indexed: 11/26/2022] Open
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24
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Liu MH, Chen QY, Harrison TJ, Li GJ, Li H, Wang XY, Ju Y, Yang JY, Fang ZL. The correlation between serum HBsAg levels and viral loads depends upon wild-type and mutated HBV sequences rather than the HBeAg/anti-HBe status. J Med Virol 2015; 87:1351-60. [PMID: 25879734 PMCID: PMC4980755 DOI: 10.1002/jmv.24186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2015] [Indexed: 12/19/2022]
Abstract
Despite several studies regarding the correlation between serum HBsAg titers and viral loads, the association remains uncertain. Eighty‐nine individuals were selected randomly from a Chinese cohort of 2,258 subjects infected persistently with hepatitis B virus (HBV) for cross‐sectional and longitudinal analysis. Viral loads of mutant HBV are lower than those of wild type HBV. The serum HBsAg titers correlate positively with viral loads in both HBeAg positive and negative subjects (r = 0.449, P = 0.013; r = 0.300, P = 0.018, respectively). No correlation between serum HBsAg titer and viral loads was found in any of the four phases of chronic HBV infection. The serum HBsAg titers correlate positively with viral loads in the group with wild type sequences of the PreS/S, basal core promoter (BCP), and preC regions of HBV(r = 0.502, P = 0.040). However, the correlation was not seen in the group with mutations in these regions (r = 0.165, P = 0.257). The correlation between HBsAg titers and viral loads was seen in individuals with wild type PreS/S sequences but not in the subgroup with BCP double mutations or PreC stop mutation, although their sequences in the preS/S regions were wild type. All these findings were confirmed by the longitudinal analysis. In conclusion, the correlation between serum HBsAg levels and viral loads may not differ between HBeAg positive and negative individuals but may depend on wild‐type or mutated genomic sequences. Therefore, HBsAg quantitation may be used as a surrogate for viral loads in only wild‐type HBV infections. J. Med. Virol. 87:1351–1360, 2015. © 2015 The Authors. Journal of Medical Virology Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Mo-Han Liu
- Department of Microbiology, School of Preclinical Medicine, Guangxi Medical University, Nanning, Guangxi, China.,Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, Guangxi, China.,Guangxi Key Laboratory for the Prevention and Control of Viral Hepatitis, Nanning, Guangxi, China
| | - Qin-Yan Chen
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, Guangxi, China.,Guangxi Key Laboratory for the Prevention and Control of Viral Hepatitis, Nanning, Guangxi, China
| | | | - Guo-Jian Li
- Department of Public Health of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Hai Li
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, Guangxi, China.,Guangxi Key Laboratory for the Prevention and Control of Viral Hepatitis, Nanning, Guangxi, China
| | - Xue-Yan Wang
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, Guangxi, China.,Guangxi Key Laboratory for the Prevention and Control of Viral Hepatitis, Nanning, Guangxi, China
| | - Yu Ju
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, Guangxi, China.,Guangxi Key Laboratory for the Prevention and Control of Viral Hepatitis, Nanning, Guangxi, China
| | - Jin-Ye Yang
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, Guangxi, China.,Guangxi Key Laboratory for the Prevention and Control of Viral Hepatitis, Nanning, Guangxi, China
| | - Zhong-Liao Fang
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, Guangxi, China.,Guangxi Key Laboratory for the Prevention and Control of Viral Hepatitis, Nanning, Guangxi, China
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25
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Carey I, Bruce M, Horner M, Zen Y, D'Antiga L, Bansal S, Vergani D, Mieli-Vergani G. HBsAg plasma level kinetics: a new role for an old marker as a therapy response predictor in vertically infected children on combination therapy. J Viral Hepat 2015; 22:441-52. [PMID: 25278170 DOI: 10.1111/jvh.12316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We aimed to investigate the ability of HBsAg plasma level kinetics to predict therapy response by studying 23 children with infancy-acquired chronic hepatitis B (CHB) during combination sequential therapy with lead-in lamivudine (LAM) and add-on interferon-α (IFN-α) [5 responders (R = anti-HBs seroconversion) and 18 nonresponders (NR)] and to assess their relationship with pretreatment intrahepatic HBV-DNA and cccDNA and HBsAg and HBcAg liver expression. Plasma HBsAg levels were measured in samples before (treatment week 0 = TW0), during (TW9, TW28, TW52) and after (follow-up week = FUW24) therapy by Abbott ARCHITECT(®) assay [log10 IU/mL]. Baseline liver HBV-DNA and cccDNA were quantified by real-time TaqMan PCR [log10 copies/ng genomic DNA]. HBsAg and HBcAg liver expression was evaluated by immunostaining of formalin-fixed, paraffin-embedded specimens [number of positive cells/1000 hepatocytes]. All results are presented as medians. Plasma: at baseline, on-treatment and during follow-up, HBsAg levels were lower in R than NR (TW0: 4.36 vs 4.75;TW28: 2.44 vs 4.35;TW52: 0 vs 4.08 and FUW24: 0.17 vs 4.35, all P < 0.05). Liver: baseline HBV-DNA (3.82 vs 4.71, P = 0.16) and cccDNA (1.98 vs 2.26, P = 0.18) tended to be lower in R than NR, HBsAg expression was lower in R than NR (0.5 vs 4.7, P = 0.03), and HBcAg expression was similar between R and NR. There were positive correlations between plasma HBsAg levels and liver HBV-DNA (r = 0.44, P = 0.04), cccDNA (r = 0.41, P = 0.04) and HBsAg liver expression (r = 0.38, P = 0.05). Lower baseline HBsAg plasma levels, lower HBsAg expression in liver and on-treatment decline of plasma HBsAg levels heralds HBsAg clearance and response to treatment in tolerant children with CHB.
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Affiliation(s)
- I Carey
- Institute of Liver Studies and Paediatric Liver, GI & Nutrition Centre, King's College London School of Medicine at King's College Hospital, London, UK
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26
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Zeng DW, Zhu YY, Huang Q, Zhang JM, Wu YL, Dong J, Jiang JJ, Liu YR. Hepatitis B surface antigen in late hepatitis B infection. J Med Virol 2014; 87:380-7. [PMID: 25604455 DOI: 10.1002/jmv.24078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2014] [Indexed: 01/04/2023]
Abstract
Hepatitis B surface antigen (HBsAg) levels are used to evaluate and monitor clinical phases of chronic hepatitis B infection but their clinical significance is unclear in the late complications, cirrhosis of the liver and hepatocellular carcinoma. This study aimed to evaluate HBsAg levels across the whole natural history of hepatitis B virus infection, including late complications. This retrospective, cross-sectional study enrolled 838 treatment-naive patients diagnosed with chronic hepatitis B infection at First Affiliated Hospital of Fujian Medical University between 2009 and 2012. Patients were classified into six groups: immunotolerance, immunoclearance, low replicative, negative hepatitis e (HBeAg) phases, liver cirrhosis, and hepatocellular carcinoma. Main outcome measures were serum HBsAg, HBeAg, HBV DNA, total bilirubin, albumin, alanine and aspartate aminotransferase, and quantitative correlation of HBsAg with HBV DNA. HBsAg levels declined significantly between clinical phases of infection (all P < 0.001) and were significantly lower in decompensated than in compensated cirrhosis (2.90 vs. 3.30, P < 0.001) but not significantly different between early versus advanced hepatocellular carcinoma. Significant positive correlations were observed between serum HBsAg and HBV DNA at immunoclearance and HBeAg negative phases, compensated and decompensated liver cirrhosis and advanced but not early hepatocellular carcinoma (all P < 0.001). HBsAg and HBV DNA were significantly higher in HBeAg positive patients with advanced hepatocellular carcinoma (P < 0.001). HBsAg levels differ significantly between chronic hepatitis B infection phases, decreasing progressively from chronic infection to cirrhosis and hepatocellular carcinoma. Significant correlations are found between serum HBsAg and HBV DNA.
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Affiliation(s)
- Da-wu Zeng
- Liver center, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
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Hepatitis B inactive carriers: An overlooked population? GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2014. [DOI: 10.1016/j.jpge.2014.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Chen GY, Zhu MF, Zheng DL, Bao YT, Wang J, Zhou X, Lou GQ. Baseline HBsAg predicts response to pegylated interferon-α2b in HBeAg-positive chronic hepatitis B patients. World J Gastroenterol 2014; 20:8195-8200. [PMID: 25009392 PMCID: PMC4081692 DOI: 10.3748/wjg.v20.i25.8195] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 01/16/2014] [Accepted: 04/09/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the predictive effect of baseline hepatitis B surface antigen (HBsAg) on response to pegylated interferon (PEG-IFN)-α2b in hepatitis B e antigen (HBeAg)-positive chronic hepatitis B (CHB) patients.
METHODS: This retrospective analysis compared the treatment efficacy of PEG-IFN-α2b alone in 55 HBeAg-positive CHB patients with different baseline HBsAg levels. Serum HBV DNA load was measured at baseline, and at 12, 24 and 48 wk of therapy. Virological response was defined as HBV DNA < 1000 IU/mL. Serum HBsAg titers were quantitatively assayed at baseline, and at 12 and 24 wk.
RESULTS: Eighteen patients had baseline HBsAg > 20 000 IU/mL, 26 patients had 1500-20000 IU/mL, and 11 patients had < 1500 IU/mL. Three (16.7%), 11 (42.3%) and seven (63.6%) patients in each group achieved a virological response at week 48, with a significant difference between groups with baseline HBsAg levels > 20000 or < 20000 IU/mL (P = 0.02). Thirteen patients had an HBsAg decline > 0.5 log10 and 30 patients < 0.5 log10 at week 12; and 6 (46.2%) and 10 (33.3%) in each group achieved virological response at week 48, with no significant difference between the two groups (P = 0.502). Eighteen patients had an HBsAg decline > 1.0 log10 and 30 patients < 1.0 log10 at week 24, and 8 (44.4%) and 11 (36.7%) achieved a virological response at week 48, with no significant difference between the two groups (P = 0.762). None of the 16 patients with HBsAg > 20000 IU/mL at week 24 achieved a virological response at week 48.
CONCLUSION: Baseline HBsAg level in combination with HBV DNA may become an effective predictor for guiding optimal therapy with PEG-IFN-α2b against HBeAg-positive CHB.
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Tan Z, Li M, Kuang X, Tang Y, Fan Y, Deng G, Wang Y, He D. Clinical implications of hepatitis B surface antigen quantitation in the natural history of chronic hepatitis B virus infection. J Clin Virol 2014; 59:228-34. [PMID: 24529415 DOI: 10.1016/j.jcv.2014.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 12/20/2013] [Accepted: 01/19/2014] [Indexed: 12/15/2022]
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Yu ML, Dai CY, Huang CF, Lee JJ, Yeh ML, Yeh SM, Kuo HT, Huang JF, Chang JM, Chen HC, Juo SHH, Hwang SJ, Chuang WL. High hepatitis B virus surface antigen levels and favorable interleukin 28B genotype predict spontaneous hepatitis C virus clearance in uremic patients. J Hepatol 2014. [PMID: 24096049 DOI: 10.1007/s12072-014-9527-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND & AIMS Host and viral factors interplay in the spontaneous clearance of hepatitis C virus (HCV) infection. We aimed to explore the roles of IL28B genotypes and hepatitis B virus (HBV) infections in spontaneous HCV seroclearance. METHODS IL28B rs8099917 genotypes, HCV and HBV markers were determined in 290 patients who were seropositive for HCV antibodies from 1681 total uremic patients on maintenance hemodialysis. RESULTS Persistent HCV viremia was observed in 74.6% (214/287) of patients. Logistic regression revealed that the strongest factors associated with spontaneous HCV seroclearance were carriage of rs8099917 TT-type (odds ratio/95% confidence intervals [OR/CI]: 6.22/1.41-27.35, p=0.016), followed by concurrent hepatitis B surface antigen (HBsAg) seropositivity (OR/CI: 2.37/1.06-5.26, p=0.035). The clearance rate was highest among patients with both positive HBsAg/rs8099917 TT-type (44.8%, OR/CI: 20.88/3.5-402.5), followed by positive HBsAg/rs8099917 non-TT-type (28.6%, OR/CI: 8.86/1.8-160.8), and negative HBsAg/rs8099917 TT-type (26.7%, OR/CI: 12.75/1.0-319.4), compared to 4% of negative HBsAg/rs8099917 non-TT-type (trend p=0.0002). HBsAg levels, but not HBV DNA levels, were significantly associated with spontaneous HCV seroclearance. Spontaneous HCV seroclearance rate was 58.3% in patients with HBsAg>200IU/ml/rs8099917 TT-type (OR/CI: 42.54/5.7-908.4), 28.0% in patients with HBsAg<200IU/ml/rs8099917 TT-type or HBsAg>200IU/ml/rs8099917 non-TT-type (OR/CI: 11.12/2.3-201.0), compared to only 3.3% in those with HBsAg<200IU/ml/rs8099917 non-TT-type (trend p=0.0004). Five of 214 (2.3%) HCV viremic patients at enrollment had spontaneous HCV seroclearance during one-year follow-up, which was associated with baseline HCV RNA and HBsAg levels. CONCLUSIONS High HBsAg levels and favorable IL28B genotype were additively associated with spontaneous HCV seroclearance in uremic patients.
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Affiliation(s)
- Ming-Lung Yu
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Yen Dai
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Preventive Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chung-Feng Huang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Occupational Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jia-Jung Lee
- Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan
| | - Ming-Lun Yeh
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Shih-Meng Yeh
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsing-Tao Kuo
- Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan; Department of Senior Citizen Service Management, Chia Nan University of Pharmacy & Science, Tainan, Taiwan
| | - Jee-Fu Huang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Jer-Ming Chang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan; Faculty of Renal Care, School of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan
| | - Hung-Chun Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan; Faculty of Renal Care, School of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan
| | - Suh-Hang Hank Juo
- Department of Medical Genetics, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shang-Jyh Hwang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan; Faculty of Renal Care, School of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan.
| | - Wan-Long Chuang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Su CW, Wu CY, Hung HH, Wu CH, Sheen IJ, Wu JC. Differential roles of serum hepatitis B virus DNA and hepatitis B surface antigen level in predicting virological breakthrough in patients receiving lamivudine therapy. J Gastroenterol Hepatol 2013; 28:1849-58. [PMID: 23730852 DOI: 10.1111/jgh.12283] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIM The role of serum hepatitis B surface antigen (HBsAg) level in determining virological breakthrough (VB) for patients with hepatitis B virus (HBV) infection receiving lamivudine remains unclear. The study aimed to evaluate the impact of serum HBsAg levels on VB among patients receiving lamivudine therapy, especially in a setting of low HBV viral load. METHODS Two hundred sixty-eight consecutive treatment-naïve patients who underwent lamivudine therapy for chronic hepatitis B were enrolled. Factors in terms of VB were analyzed by multivariate analysis. RESULTS After a median treatment duration of 67.1 weeks, 102 patients had VB. Multivariate analysis showed that positive hepatitis B e antigen (HBeAg) (hazard ratio 2.165, P = 0.026) and HBV DNA levels ≥ 2000 IU/mL after 6 months of lamivudine therapy (hazard ratio 5.236, P = 0.001) were independent risk factors predicting VB. The cumulative VB rates stratified by HBeAg-positive and -negative at 3 years were 44.7% and 26.3%, respectively. At 3 years, the cumulative VB rates stratified by the HBV DNA < 2000 and ≥ 2000 IU/mL after 6 months of therapy were 25.5% and 79.4%, respectively. For HBeAg-positive patients with serum HBV DNA < 2000 IU/mL after 6 months of therapy, baseline HBsAg levels ≥ 20,000 IU/mL was the only risk factor associated with VB. CONCLUSIONS For chronic hepatitis B patients treated with lamivudine, serum HBV DNA level > 2000 IU/mL after 6 months of therapy could predict subsequent VB. In patients with lower on-treatment viral load, baseline serum HBsAg level is associated with the emergence of VB, especially for those with serum positive HBeAg.
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Affiliation(s)
- Chien-Wei Su
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Xun YH, Zang GQ, Guo JC, Yu XL, Liu H, Xiang J, Liu J, Shi JP. Serum hepatitis B surface antigen quantification as a useful assessment for significant fibrosis in hepatitis B e antigen-positive hepatitis B virus carriers. J Gastroenterol Hepatol 2013; 28:1746-55. [PMID: 23800140 DOI: 10.1111/jgh.12304] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/28/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS The role of serum quantitative hepatitis B surface antigen (qHBsAg) in identifying hepatitis B virus (HBV) carriers with significant fibrosis is unknown. This study aims to evaluate the diagnostic value of qHBsAg for hepatic fibrosis in hepatitis B e antigen (HBeAg)-positive HBV carriers. METHODS Consecutive biopsy-proven HBeAg-positive HBV carriers were prospectively recruited in our center from 2009 to 2011 and were randomly divided into training and validation set. Area under receiver-operator curve (AUC) was used to determine the diagnostic accuracy of simple tests for significant fibrosis (Scheuer stage, F ≥ 2). RESULTS Overall, a total of 197 eligible patients (median age 31 years; 149 males) were enrolled. The median qHBsAg was 4.20 (log10 IU/mL). Significant fibrosis was confirmed in 112 (56.9%) patients. By logistical regression analysis, qHBsAg and γ-glutamyl transpeptidase were identified as predictors for significant fibrosis in training set (n = 124). Thus, qHBsAg index and γ-glutamyl transpeptidase to qHBsAg ratio (GqHBsR) were selected for the subsequent analysis. In the training set, an AUC of 0.762, 0.826, 0.749, and 0.771 was observed for qHBsAg index, GqHBsR, FIB-4, and aspartate aminotransferase to platelet ratio index, respectively (all P < 0.05). GqHBsR yielded a higher AUC than aspartate aminotransferase to platelet ratio index and FIB-4 (both P < 0.05). Using the optimal cut-off of 7.78, GqHBsR showed a sensitivity of 78.9% and a specificity of 73.6%. About 80% of liver biopsy could be avoided in the entire cohort. CONCLUSIONS Serum qHBsAg-based simple tests, especially GqHBsR, can accurately and specifically identify significant fibrosis in treatment-naïve HBeAg-positive HBV carriers.
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Affiliation(s)
- Yun-Hao Xun
- Department of Infectious Diseases, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China; Department of Liver Diseases, The Sixth People's Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
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Sokal EM, Paganelli M, Wirth S, Socha P, Vajro P, Lacaille F, Kelly D, Mieli-Vergani G. Management of chronic hepatitis B in childhood: ESPGHAN clinical practice guidelines: consensus of an expert panel on behalf of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition. J Hepatol 2013; 59:814-29. [PMID: 23707367 DOI: 10.1016/j.jhep.2013.05.016] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 05/09/2013] [Accepted: 05/13/2013] [Indexed: 02/06/2023]
Affiliation(s)
- Etienne M Sokal
- Pediatric Gastroenterology & Hepatology, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain and Cliniques Universitaires Saint Luc, Brussels, Belgium.
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Peng CY, Lai HC, Li YF, Su WP, Chuang PH, Kao JT. Early serum HBsAg level as a strong predictor of sustained response to peginterferon alfa-2a in HBeAg-negative chronic hepatitis B. Aliment Pharmacol Ther 2012; 35:458-68. [PMID: 22225574 DOI: 10.1111/j.1365-2036.2011.04973.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Revised: 10/16/2011] [Accepted: 12/12/2011] [Indexed: 12/19/2022]
Abstract
BACKGROUND The roles remain unclear of early on-treatment quantitative serum HBsAg and hepatitis B virus (HBV) DNA levels in the prediction of a sustained response (SR) to peginterferon alfa-2a therapy in HBeAg-negative chronic hepatitis B (CHB) patients infected with genotype B or C. AIMS To determine their roles in HBeAg-negative CHB patients infected with genotype B or C. METHODS Sixty-one patients were treated with peginterferon alfa-2a for 48 weeks. Serum HBsAg levels were quantified using the Abbott Architect HBsAg QT assay throughout treatment. Multiple regression analyses were performed to identify independent predictors of SR. RESULTS Nineteen patients (31%) achieved SR with serum HBV DNA levels <312 copies/mL at 24 weeks post-treatment. Serum HBsAg levels at 12 (OR 31.9; 95% CI 4.8-209.6; P = 0.0003) and 24 weeks of therapy (OR 8.8; 95% CI 2.0-38.0; P = 0.0035), and HBV DNA levels at baseline (OR 7.0; 95% CI 1.3-36.2; P = 0.0203), 12 (OR 7.9; 95% CI 1.2-48.4; P = 0.0249) and 24 weeks of therapy (OR 22.3; 95% CI 2.2-224.0; P = 0.0083) were early independent predictors of SR. A serum HBsAg cut-off of 150 IU/mL at week 12 had an AUC, sensitivity, specificity and positive and negative predictive values of 0.75, 63%, 95%, 86% and 85% with respect to predicting SR respectively. CONCLUSIONS A quantitative serum HBsAg level at 12 weeks of therapy can be used for the early prediction of SR to peginterferon therapy in HBeAg-negative CHB patients infected with genotype B or C.
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Affiliation(s)
- C-Y Peng
- School of Medicine, China Medical University, No. 2 Yuh-Der Road, Taichung, Taiwan.
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