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Chtourou A, Gargouri S, Elleuch E, Feki L, Smaoui F, Taktak A, Mnif K, Kassis M, Hammami A, Ben Jemaa M, Karray H. Large spontaneous HBV DNA fluctuations and potential usefulness of a single-point measurement of combined HBV DNA and quantitative HBsAg for the exclusion of HBeAg-negative chronic hepatitis B: A prospective Tunisian cohort study. Arab J Gastroenterol 2023; 24:223-229. [PMID: 37989673 DOI: 10.1016/j.ajg.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 03/10/2023] [Accepted: 09/04/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND AND STUDY AIM During the natural course of HBeAg-negative chronic hepatitis B (CHB), fluctuations in hepatitis B virus (HBV) DNA and alanine aminotransferase (ALT) levels are often observed, making the classification of patients difficult. We aimed to describe spontaneous short-term HBV DNA level fluctuations and to assess the usefulness of qHBsAg in Tunisian patients with HBeAg-negative chronic HBV infection. PATIENTS AND METHODS We included 174 treatment-naive Tunisian patients with HBeAg-negative chronic HBeAg-negative HBV infection. A prospective 1-year follow-up was conducted with serial determinations of HBV DNA, ALT levels, and qHBsAg. The patients were classified into three groups: inactive carriers (G1), patients with negative HBeAg CHB (G2), and patients with an "indeterminate state" (G3). For the latter group, a liver biopsy was indicated. RESULTS Only genotype D was detected. During follow-up, 21.6% and 19.5% of patients with a low initial (<2,000 IU/ml) and intermediate viral load (2,000-20,000 IU/ml) experienced a subsequent increase in their HBV DNA levels above 2,000 and 20,000 IU/ml, respectively. Significant variations in viral load were observed in 61.1% of patients at 6-month intervals. Among the 174 patients, 89 (51.1%) belonged to G1, 33 (19%) to G2, and 52 (29.9%) to G3. Fourteen patients have undergone a liver biopsy, of whom seven showed moderate to severe liver disease. Combination of HBV DNA < 2,000 IU/ml and qHBsAg < 832 IU/ml excluded CHB in 98.4% of cases. A cutoff point for qHBsAg < 100 IU/ml associated with an annual decline of > 0.5 log 10 IU/ml is a good predictor marker of functional cure for hepatitis B. CONCLUSIONS This study highlights the large short-term fluctuations in HBV DNA in patients with HBeAg-negative chronic HBeAg-negative HBV infection with genotype D. Thus, using the cutoff value of 832 for qHBsAg combined with that of 2,000 for HBV DNA makes it possible to exclude CHB for most patients.
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Affiliation(s)
- Amel Chtourou
- Laboratory of Microbiology, Habib Bourguiba University Hospital, Rue El Ferdaous, 3029 Sfax, Tunisia; Faculty of Medicine of Sfax, Avenue Majida Boulila, 3003 Sfax, Tunisia; University of Sfax, Sfax, Tunisia.
| | - Saba Gargouri
- Laboratory of Microbiology, Habib Bourguiba University Hospital, Rue El Ferdaous, 3029 Sfax, Tunisia; Faculty of Medicine of Sfax, Avenue Majida Boulila, 3003 Sfax, Tunisia; University of Sfax, Sfax, Tunisia.
| | - Emna Elleuch
- Faculty of Medicine of Sfax, Avenue Majida Boulila, 3003 Sfax, Tunisia; University of Sfax, Sfax, Tunisia; Infectious Diseases Department, Hedi Chaker University Hospital, route el ain, km 0.5, Sfax, Tunisia
| | - Lamia Feki
- Laboratory of Microbiology, Habib Bourguiba University Hospital, Rue El Ferdaous, 3029 Sfax, Tunisia; Faculty of Medicine of Sfax, Avenue Majida Boulila, 3003 Sfax, Tunisia; University of Sfax, Sfax, Tunisia.
| | - Fahmi Smaoui
- Laboratory of Microbiology, Habib Bourguiba University Hospital, Rue El Ferdaous, 3029 Sfax, Tunisia; Faculty of Medicine of Sfax, Avenue Majida Boulila, 3003 Sfax, Tunisia; University of Sfax, Sfax, Tunisia.
| | - Awatef Taktak
- Laboratory of Microbiology, Habib Bourguiba University Hospital, Rue El Ferdaous, 3029 Sfax, Tunisia; Faculty of Medicine of Sfax, Avenue Majida Boulila, 3003 Sfax, Tunisia; University of Sfax, Sfax, Tunisia.
| | - Khouloud Mnif
- Faculty of Medicine of Sfax, Avenue Majida Boulila, 3003 Sfax, Tunisia; University of Sfax, Sfax, Tunisia; Infectious Diseases Department, Hedi Chaker University Hospital, route el ain, km 0.5, Sfax, Tunisia.
| | - Mondher Kassis
- University of Sfax, Sfax, Tunisia; Department of Social Medicine, Faculty of Medicine of Sfax, Avenue Majida Boulila, 3003 Sfax, Tunisia.
| | - Adnene Hammami
- Laboratory of Microbiology, Habib Bourguiba University Hospital, Rue El Ferdaous, 3029 Sfax, Tunisia; Faculty of Medicine of Sfax, Avenue Majida Boulila, 3003 Sfax, Tunisia; University of Sfax, Sfax, Tunisia.
| | - Mounir Ben Jemaa
- Faculty of Medicine of Sfax, Avenue Majida Boulila, 3003 Sfax, Tunisia; University of Sfax, Sfax, Tunisia; Infectious Diseases Department, Hedi Chaker University Hospital, route el ain, km 0.5, Sfax, Tunisia.
| | - Hela Karray
- Laboratory of Microbiology, Habib Bourguiba University Hospital, Rue El Ferdaous, 3029 Sfax, Tunisia; Faculty of Medicine of Sfax, Avenue Majida Boulila, 3003 Sfax, Tunisia; University of Sfax, Sfax, Tunisia.
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Yoshida O, Akbar SMF, Imai Y, Sanada T, Tsukiyama-Kohara K, Miyazaki T, Kamishita T, Miyake T, Tokumoto Y, Hikita H, Tsuge M, Shimizu M, Al Mahtab M, Aguilar JC, Guillen G, Kohara M, Hiasa Y. Intranasal therapeutic vaccine containing HBsAg and HBcAg for patients with chronic hepatitis B; 18 months follow-up results of phase IIa clinical study. Hepatol Res 2023; 53:196-207. [PMID: 36399406 DOI: 10.1111/hepr.13851] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 11/19/2022]
Abstract
AIMS HBsAg loss with anti-HBs acquisition is considered a functional cure and ideal treatment goal for patients with CHB. Our group have reported the efficacy of therapeutic vaccine with HBsAg and HBcAg (NASVAC) by intranasal and subcutaneous injection. In this study, we investigated the safety and efficacy of newly developed CVP-NASVAC, which contained NASVAC with mucoadhesive carboxyl vinyl polymer (CVP) in the dedicated device. METHODS A single dose, open-label, phase IIa clinical trial of CVP-NASVAC was conducted. Patients with CHB treated with nucleoside/nucleotide analogs (NAs) and HBV carriers not undergoing anti-HBV treatment were enrolled. CVP-NASVAC was injected through the nose for, in total, 10 times. Participants were followed-up for 18 months, and their HBsAg reduction and anti-HBs induction assessed as endpoints. RESULTS Among the patients with CHB treated with NAs (n = 27) and HBV carriers without NAs (n = 36), 74.1% and 75.0% exhibited reductions in their baseline HBsAg, and the mean reductions were -0.1454 log10 IU/ml (p < 0.05) and -0.2677 log10 IU/ml (p < 0.05), respectively. Anti-HBs antibody was detected in 40.7% and 58.3% of patients treated with and without NAs, respectively. Six of 71 (9.5%) patients were functionally cured after the CVP-NASVAC treatment. CONCLUSIONS Anti-HBs induction and HBsAg reduction was observed after CVP-NASVAC treatment in some patients with CHB. The CVP-NASVAC is a safe treatment, which might expect to achieve functional cure for patients with CHB.
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Affiliation(s)
- Osamu Yoshida
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Sheikh Mohammad Fazle Akbar
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Yusuke Imai
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Takahiro Sanada
- Department of Microbiology and Cell Biology, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | | | | | | | - Teruki Miyake
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Yoshio Tokumoto
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Hayato Hikita
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masataka Tsuge
- Department of Gastroenterology and Metabolism, Hiroshima University, Hiroshima, Japan
| | - Masahito Shimizu
- Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Mamun Al Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Julio Cesar Aguilar
- Vaccine Division, Biomedical Research Department, Center for Genetic Engineering and Biotechnology, Havana City, Cuba
| | - Gerardo Guillen
- Vaccine Division, Biomedical Research Department, Center for Genetic Engineering and Biotechnology, Havana City, Cuba
| | - Michinori Kohara
- Department of Microbiology and Cell Biology, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Yoichi Hiasa
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
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Huang Y, Li X, Zheng X, Tian X, Yu M, Sha L, Liu Y, Chong Y, Hao Y, You X. Bayesian network to predict hepatitis B surface antigen seroclearance in chronic hepatitis B patients. J Viral Hepat 2020; 27:1326-1337. [PMID: 32741055 DOI: 10.1111/jvh.13368] [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: 01/03/2020] [Revised: 07/10/2020] [Accepted: 07/19/2020] [Indexed: 12/09/2022]
Abstract
There is a need for an interpretable, accurate and interactions-considered model for predicting hepatitis B surface antigen (HBsAg) seroclearance. We aimed to construct a Bayesian network (BN) model using available medical records to predict HBsAg seroclearance in chronic hepatitis B (CHB) patients, and to evaluate the model's performance. This was a case-control study. A total of 1966 consecutive CHB patients (mean age 39.04 ± 11.23 years) between January 2006 and June 2015 were included. The demographic and clinical characteristics, laboratory data and imaging parameters were obtained and used to build a BN model to estimate the probability of HBsAg seroclearance. Baseline serum HBsAg and hepatitis Be antigen (HBeAg) levels, virological response and HBeAg seroclearance were the most significant predictors of HBsAg seroclearance. The post-test probability table showed that patients with baseline HBsAg concentrations ≤2000 IU/mL, negative baseline HBeAg, an initial virological response and without HBeAg seroclearance (i.e. no recurrence of HBeAg positivity during follow-up) were most likely to have HBsAg seroclearance. The constructed BN model had an area under the receiver operating characteristic curves of 0.896 (95% confidence interval [CI]: 0.892, 0.899), a sensitivity of 0.840 (95% CI: 0.833, 0.846), a specificity of 0.880 (95% CI: 0.876, 0.884) and an accuracy of 0.878 (95% CI: 0.874, 0.882) for predicting HBsAg seroclearance. The established BN model accurately estimated the probability of HBsAg seroclearance and is a promising tool to assist clinical decision-making.
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Affiliation(s)
- Yun Huang
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Xiangyong Li
- Department of Infectious Diseases, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiaoyan Zheng
- Department of Infectious Diseases, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiaolu Tian
- Department of Big Data, China Construction Bank Fintech Co. Ltd., Shenzhen, China
| | - Mingxue Yu
- Department of Infectious Diseases, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Liuping Sha
- Department of Infectious Diseases, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yinhui Liu
- Department of Infectious Diseases, People's Hospital of Foshan Sanshui Dictrict, Foshan, China
| | - Yutian Chong
- Department of Infectious Diseases, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yuantao Hao
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Xu You
- Department of Clinical Laboratory, the Third Affiliated Hospital, Southern Medical University, Guangzhou, China
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Lin TC, Chiu YC, Chiu HC, Liu WC, Cheng PN, Chen CY, Chang TT, Wu IC. Clinical utility of hepatitis B surface antigen kinetics in treatment-naïve chronic hepatitis B patients during long-term entecavir therapy. World J Gastroenterol 2018; 24:725-736. [PMID: 29456411 PMCID: PMC5807675 DOI: 10.3748/wjg.v24.i6.725] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 11/17/2017] [Accepted: 11/27/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the utility of hepatitis B surface antigen (HBsAg) kinetics in chronic hepatitis B patients during long-term entecavir treatment.
METHODS This retrospective study included treatment-naïve chronic hepatitis B patients who received at least 2 years of consecutive entecavir treatment. Patients were followed up at three to six month intervals with liver biochemistry, hepatitis B virus DNA, and abdominal sonography. In hepatitis B e antigen (HBeAg)-positive patients, HBeAg levels were assessed every three to six month until results became negative. Serum HBsAg levels were determined at the baseline, one-year and five-year time points. Liver cirrhosis was diagnosed through liver biopsy, imaging examinations, or clinical findings of portal hypertension. Hepatocellular carcinoma was diagnosed by histological examination or dynamic image studies.
RESULTS A total of 211 patients were enrolled. The median treatment time was 5.24 (2.00-9.62) years. Multivariate analysis showed that lower baseline HBsAg levels were associated with an earlier virological response, earlier hepatitis B e antigen (HBeAg) seroconversion, and earlier biochemical response in HBeAg-positive patients (cut-off value: 4 log IU/mL) and an earlier virological response in HBeAg-negative non-cirrhotic patients (cut-off value: 2.4 log IU/mL). Although HBsAg levels decreased slowly during long-term entecavir treatment, higher HBsAg decrease rates were found in the first year for HBeAg-positive non-cirrhotic patients, and patients with higher baseline HBsAg levels. More favorable clinical outcomes were not observed by a rapid HBsAg decline per se, but depended on lower baseline HBsAg levels.
CONCLUSION Baseline HBsAg can be used to predict treatment responses. HBsAg levels and decrease rates should be considered together according to disease status while interpreting HBsAg changes.
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Affiliation(s)
- Tien-Ching Lin
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, 70403, Taiwan
| | - Yen-Cheng Chiu
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, 70403, Taiwan
| | - Hung-Chih Chiu
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, 70403, Taiwan
| | - Wen-Chun Liu
- Infectious Disease and Signaling Research Center, National Cheng Kung University, Tainan 70403, Taiwan
| | - Pin-Nan Cheng
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, 70403, Taiwan
| | - Chiung-Yu Chen
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, 70403, Taiwan
| | - Ting-Tsung Chang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, 70403, Taiwan
- Infectious Disease and Signaling Research Center, National Cheng Kung University, Tainan 70403, Taiwan
| | - I-Chin Wu
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, 70403, Taiwan
- Infectious Disease and Signaling Research Center, National Cheng Kung University, Tainan 70403, Taiwan
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5
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Brouwer WP, Chan HLY, Brunetto MR, Martinot-Peignoux M, Arends P, Cornberg M, Cherubini B, Thompson AJV, Liaw YF, Marcellin P, Janssen HLA, Hansen BE. Repeated Measurements of Hepatitis B Surface Antigen Identify Carriers of Inactive HBV During Long-term Follow-up. Clin Gastroenterol Hepatol 2016; 14:1481-1489.e5. [PMID: 26872398 DOI: 10.1016/j.cgh.2016.01.019] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 01/27/2016] [Accepted: 01/27/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Measurements of hepatitis B surface antigen (HBsAg) and hepatitis B virus (HBV) DNA might help to identify carriers of inactive HBV. We assessed the performance of repeated measurements of HBsAg over a median time period of 8 years. METHODS We performed a retrospective study of 292 HBe antigen-negative patients with chronic HBV infection, normal levels of alanine aminotransferase (ALT), levels of HBV DNA <20,000 IU/mL, and no cirrhosis who visited the outpatient clinics at 8 tertiary care centers in Europe, Asia, and Australia from 1990 through 2011. Patients were determined to be carriers of inactive HBV (level of HBV DNA <2000 IU/mL and serum levels of ALT that remained normal) or to have HBV activity (level of HBV DNA fluctuating >2000 IU/mL and/or abnormal levels of ALT) after each year of follow-up. Patients were followed for a median time of 8 years (range, 4-9 years). Dynamic regression analysis was used to study changes in level of HBsAg and HBV phase and to update the risk of HBV activity. RESULTS One year after study enrollment, 189 patients (65%) had inactive HBV and 103 patients (35%) had HBV activity. Based on dynamic analysis, the probability that a patient would have HBV at any following year differed according to level of HBsAg; odds were 97% for patients with initial level of HBsAg <100 IU/mL, 85% for patients with initial levels 100-1000 IU/mL, and 76% for patients with initial levels >1000 IU/mL (P < .001). Having inactive virus for any 2 consecutive years predicted having inactive virus in any third year. However, 15% of patients with level of HBsAg >100 IU/mL had HBV activity in the third year. The combination of HBsAg level <100 IU/mL and HBV DNA level <2000 IU/mL identified patients whose virus remained inactive for the entire follow-up period, with 98% specificity and a positive predictive value of 97%, for all HBV genotypes. Patients with HBV activity who had levels of HBV DNA <5000 IU/mL and decreases in HBsAg of 0.5 log IU/mL or more for 1 year had a high probability of becoming carriers of inactive HBV in the next year. CONCLUSIONS In a retrospective, dynamic analysis of almost 300 patients with chronic HBV infection, we found that levels of HBsAg <100 IU/mL identify patients with inactive virus with a high level of specificity. HBsAg levels should therefore be used to define phases of HBV infection in HBe antigen-negative patients.
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Affiliation(s)
- Willem P Brouwer
- Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands.
| | - Henry Lik-Yuen Chan
- Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China
| | | | | | - Pauline Arends
- Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands
| | - Markus Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | | | - Alex J V Thompson
- St. Vincent's Hospital and the University of Melbourne, Melbourne, Australia
| | - Yun-Fan Liaw
- Liver Research Unit, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
| | - Patrick Marcellin
- Centre de Recherche Biomédicale Bichat-Beaujon, Université Paris-Diderot, Clichy, France
| | - Harry L A Janssen
- Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands; UHN Liver Clinic, Toronto Western and General Hospital, University Health Network Toronto, Toronto, Canada
| | - Bettina E Hansen
- Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands; Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
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Hepatitis B virus genotypes: epidemiological and clinical relevance in Asia. Hepatol Int 2016; 10:854-860. [PMID: 27300749 DOI: 10.1007/s12072-016-9745-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 05/27/2016] [Indexed: 02/08/2023]
Abstract
Hepatitis B virus (HBV) is characterized by a high genetic heterogeneity since it replicates via a reverse transcriptase that lacks proofreading ability. Up to now, ten genotypes (A-J) have been described, with genotype A and D being ubiquitous but most prevalent in Europe and Africa, genotype B and C being confined to Asia and Oceania. Infections with other genotypes such as E, F, G and H are also occasionally observed in Asia. Genotype I is rare and can be found in Laos, Vietnam, India and China, whereas genotype J has been described in Japan and Ryukyu. Novel variants generated by recombination and co-infection with other genotypes have gradually gotten worldwide attention and may be correlated with certain clinical features. There are substantial differences in HBV infection regarding prevalence, clinical manifestation, disease progression and response to antiviral therapy. Due to the complex interplay among viral, host and environmental factors, the relationship between HBV genotypes and clinical profiles remains incompletely revealed. In general, genotype A is associated with better response to interferon therapy; genotype C, and to lesser extent B, usually represent a risk factor for perinatal infection and are associated with advanced liver diseases such as cirrhosis and hepatocellular carcinoma; genotype D may be linked with poor response to interferon therapy. Future studies with better design and larger sample size are warranted to further clarify the controversial issues and guide the day-to-day clinical practice.
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Role of serum quantitative hepatitis B surface antigen (HBsAg) in HBsAg carriers in a follow-up community study. Kaohsiung J Med Sci 2015; 31:386-7. [DOI: 10.1016/j.kjms.2015.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 04/08/2015] [Indexed: 11/23/2022] Open
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Abstract
At least 10 hepatitis B virus (HBV) genotypes (A to J) with distinct geographic distributions and several HBV mutants, including precore/core promoter mutations and pre-S/S deletion mutations, have been recognized to be not only predictive of liver disease progression but also associated with response to antiviral therapy. HBV genotype-specific pathogenesis may contribute to heterogeneous clinical outcomes in chronic hepatitis B patients across the world. For example, patients with HBV genotypes C and D infection have a lower rate of spontaneous HBeAg seroconversion. In addition, HBV genotypes C and D have a higher frequency of core promoter and pre-S mutations than genotypes A and B. Genotypes C and D also carry a higher lifetime risk of cirrhosis and HCC development than genotypes A and B. Core promoter and pre-S mutations also correlate with an increased risk of hepatocellular carcinoma (HCC). Therapeutically, genotypes A and B patients have a better response to interferon-based therapy than genotypes C and D patients, but the response to nucleos(t)ide analogs is comparable across different HBV genotypes. In conclusion, HBV genotypes and variants may serve as viral genetic markers to predict disease progression as well as help practicing physicians optimize individualized antiviral therapy in clinical practice.
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Affiliation(s)
- Chih-Lin Lin
- Department of Gastroenterology, Ren-Ai Branch, Taipei City Hospital, Taipei 106, Taiwan Department of Psychology, National Chengchi University, Taipei 106, Taiwan
| | - Jia-Horng Kao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei 100, Taiwan Hepatitis Research Center, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei 100, Taiwan Department of Medical Research, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei 100, Taiwan
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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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Abstract
Chronic hepatitis B virus (HBV) infection is a global health problem, leading to cirrhosis, hepatocellular carcinoma (HCC) and liver-related deaths. Universal hepatitis B vaccination is the most cost-effective way to eradicate HBV infection with the remarkable reduction of chronic carriage, neonatal fulminant hepatitis and childhood HCC. The introduction of highly effective antiviral agents, including lamivudine, adefovir dipivoxil, entecavir, telbivudine, tenofovir disoproxil fumarate and pegylated interferons further improve short-, medium- and long-term outcomes of chronic HBV infection, such as ALT normalization, HBV DNA suppression, HBeAg seroconversion, HBsAg seroclearance, fibrosis regression, reduction of cirrhosis, HCC, liver-related deaths and the need for liver transplantation. Above all, sustained and profound viral suppression is the key to improve the clinical outcomes of chronic hepatitis B.
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Affiliation(s)
- Tung-Hung Su
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, 1 Chang-Te Street, Taipei 10002, Taiwan
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11
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Liu TW, Yeh ML, Huang CF, Lin IL, Huang JF, Dai CY, Chen YL, Chuang WL, Yu ML. Clinical performance of a new hepatitis B surface antigen quantitative assay with automatic dilution. Kaohsiung J Med Sci 2014; 31:26-33. [PMID: 25600917 DOI: 10.1016/j.kjms.2014.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 07/13/2014] [Accepted: 08/16/2014] [Indexed: 12/22/2022] Open
Abstract
Hepatitis B virus surface antigen (HBsAg) levels reflect disease status and can predict the clinical response to antiviral treatment; however, the emergence of HBsAg mutant strains has become a challenge. The Abbott HBsAg quantification assay provides enhanced detection of HBsAg and HBsAg mutants. We aimed to evaluate the performance of the Abbott HBsAg quantification assay with automatic sample dilutions (shortened as automatic Architect assay), compared with the Abbott HBsAg quantification assay with manual sample dilutions (shortened as manual Architect assay) and the Roche HBsAg quantification assay with automatic sample dilutions (shortened as Elecsys). A total of 130 sera samples obtained from 87 hepatitis B virus (HBV)-infected patients were collected to assess the correlation between the automatic and manual Architect assays. Among the 87 patients, 41 provided 42 sera samples to confirm the linearity and reproducibility of the automatic Architect assay, and find out the correlation among the Elecsys and two Architect assays. The coefficients of variation (0.44-9.53%) and R(2) = 0.996-1, which were both determined using values obtained from the automatic Architect assay, showed good reproducibility and linearity. Results of the two Architect assays demonstrated a feasible correlation (n = 130 samples; R = 0.898, p < 0.01). With regard to subgroups, correlations between the two Architect assays were better in the hepatitis B e antigen (HBeAg)-negative group (HBeAg-negative group vs. HBeAg-positive group: R = 0.885 vs. R = 0.865, both p < 0.01) and low HBV DNA group (low DNA group vs. high DNA group: R = 0.886 vs. R = 0.844, both p < 0.01). Significant correlations were also found between the results of the Elecsys and Architect assays (R > 0.93 in all cases). In conclusion, the correlation between the automatic and manual dilution Architect assays was feasible, particularly in the HBeAg-negative and low DNA groups. With lower labor costs and less human error than the manual version, the Abbott automatic dilution Architect assay provided a good clinical performance with regard to the HBsAg levels.
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Affiliation(s)
- Ta-Wei Liu
- Division of Hepatobiliary, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ming-Lun Yeh
- Division of Hepatobiliary, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Feng Huang
- College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Occupational Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - I-Ling Lin
- Department of Medical Laboratory Science and Biotechnology, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jee-Fu Huang
- College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Yen Dai
- Division of Hepatobiliary, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yao-Li Chen
- College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of General Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan.
| | - Wan-Long Chuang
- Division of Hepatobiliary, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Lung Yu
- Division of Hepatobiliary, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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12
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Kuo YH, Chang KC, Wang JH, Tsai PS, Hung SF, Hung CH, Lu SN. Changing serum levels of quantitative hepatitis B surface antigen and hepatitis B virus DNA in hepatitis B virus surface antigen carriers: a follow-up study of an elderly cohort. Kaohsiung J Med Sci 2014; 31:102-7. [PMID: 25645989 DOI: 10.1016/j.kjms.2014.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 08/21/2014] [Accepted: 08/29/2014] [Indexed: 12/16/2022] Open
Abstract
This study was to elucidate longitudinally quantitative changes of hepatitis B virus (HBV) surface antigen (HBsAg) and HBV DNA in elder HBsAg carriers in a community. Among 1002 residents screened for HBsAg in 2005, 405 responded to this follow-up study in 2010. Fifty-nine (14.6%) were HBsAg carriers in 2005; HBsAg quantification and HBV DNA were measured. HBsAg quantification (cutoff 1600 IU/mL) and HBV DNA (cutoff 2000 IU/mL) were combined to stratify the participants between two screens. A total of 30 men and 29 women with a mean age of 63.9 ± 7.9 years were enrolled. Quantitative levels of HBsAg and HBV DNA were significantly correlated in 2005 (r = 0.509, p < 0.001) and 2010 (r = 0.777, p < 0.001). Concentrations of HBsAg (IU/mL) significantly decreased from 2.2 ± 1.0 log in 2005 to 1.7 ± 1.5 log in 2010 (p < 0.001). The level of HBsAg was decreased in 48 (81.4%) individuals and HBsAg was undetectable in eight (13.6%). The annual incidence of HBsAg clearance was 2.7%. These 59 HBsAg carriers in 2005 were divided into four groups: low HBsAg low HBV DNA (n = 32), high HBsAg low HBV DNA (n = 5), low HBsAg high HBV DNA (n = 12) and high HBsAg high HBV DNA (n = 10). All 32 individuals in the low HBsAg low HBV DNA group were still in that group in 2010, whereas only two of the high HBsAg high HBV DNA group became inactive. As with a younger cohort in hospital, HBsAg quantification was still well correlated with HBV DNA in elderly HBsAg carriers in the community. Lower levels of both HBsAg and HBV DNA might represent an inactive HBV infection.
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Affiliation(s)
- Yuan-Hung Kuo
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuo-Ching Chang
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jing-Houng Wang
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pei-Shan Tsai
- Health Center of Zihguan Township, Kaohsiung, Taiwan
| | - Shu-Feng Hung
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chao-Hung Hung
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Nan Lu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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13
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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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14
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Li MR, Xi HL, Wang QH, Hou FQ, Huo N, Zhang XX, Li F, Xu XY. Kinetics and prediction of HBsAg loss during long-term therapy with nucleos(t)ide analogues of different potency in patients with chronic hepatitis B. PLoS One 2014; 9:e98476. [PMID: 24905586 PMCID: PMC4048200 DOI: 10.1371/journal.pone.0098476] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 05/04/2014] [Indexed: 01/28/2023] Open
Abstract
Background & Aims About 350–400 million people are infected with hepatitis B virus (HBV) chronically and 1 million people die of hepatitis B virus (HBV)-related liver diseases. Nucleos(t)ide analogues (NAs) have been used for the treatment against HBV. However, few studies have investigated the long-term effects of different nucleos(t)ide analogues on levels of hepatitis B surface antigen (HBsAg) in patients with chronic hepatitis B (CHB). The aims of this study were to measure the magnitude of HBsAg reduction by long-term monotherapy with adefovir dipivoxil (ADV) and entecavir (ETV), to compare HBsAg reduction between the two drugs of different potency and to predict the expected time needed to achieve HBsAg loss. Methods We retrospectively evaluated the kinetics of HBsAg in 67 patients with CHB who all exhibited persistent viral suppression. These patients were treated with ADV or ETV for at least 6 years. HBV genotype was determined at baseline. Liver biochemistry, HBV serological markers, serum HBV DNA and HBsAg titers were determined at baseline, half year and yearly from year 1 to 6. Results Serum HBsAg titers after treatment with ADV or ETV were significantly lower than the baseline titers (P<0.05). HBsAg reduction rate of patients treated with ETV (0.11 log10 IU/mL/ year) was higher than that treated with ADV (0.10 log10 IU/mL/year), and the calculated expected time to HBsAg loss for patients treated with ETV (approximate 24.99 years) was shorter than that with ADV (approximate 30.33 years), but there was no statistically significant difference between two groups (P>0.05). Conclusion Serum HBsAg titers gradually decreased during long-term treatment with either ADV or ETV. It appears that the potency of ADV on HBsAg reduction is close to that of ETV, as long as patients have achieved persistent viral suppression.
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Affiliation(s)
- Min-Ran Li
- Department of Infectious Diseases, Peking University First Hospital, Beijing, China
| | - Hong-Li Xi
- Department of Infectious Diseases, Peking University First Hospital, Beijing, China
| | - Qin-Huan Wang
- Department of Infectious Diseases, Peking University First Hospital, Beijing, China
| | - Feng-Qin Hou
- Department of Infectious Diseases, Peking University First Hospital, Beijing, China
| | - Na Huo
- Department of Infectious Diseases, Peking University First Hospital, Beijing, China
| | - Xia-Xia Zhang
- Department of Infectious Diseases, Peking University First Hospital, Beijing, China
| | - Fang Li
- Department of Infectious Diseases, Peking University First Hospital, Beijing, China
| | - Xiao-Yuan Xu
- Department of Infectious Diseases, Peking University First Hospital, Beijing, China
- * E-mail:
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15
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Tseng TC, Liu CJ, Yang WT, Chen CL, Yang HC, Su TH, Wang CC, Kuo SFT, Liu CH, Chen PJ, Chen DS, Kao JH. Hepatitis B surface antigen level complements viral load in predicting viral reactivation in spontaneous HBeAg seroconverters. J Gastroenterol Hepatol 2014; 29:1242-9. [PMID: 24384028 DOI: 10.1111/jgh.12502] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2013] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIMS The level of hepatitis B surface antigen (HBsAg) has been shown to complement hepatitis B virus (HBV)-DNA level in predicting disease progression in hepatitis B e antigen (HBeAg)-negative patients, especially those with low viral loads. Whether this finding could be seen in spontaneous HBeAg seroconverters remains unclear. METHODS A retrospective cohort of 390 Taiwanese spontaneous HBeAg seroconverters with a mean follow-up period of 7.4 years was enrolled. The relationships between HBV-DNA/HBsAg levels and HBeAg-negative hepatitis/active viral replication (HBV-DNA level ≥ 2000 IU/mL) were investigated. RESULTS In the overall cohort, serum HBV-DNA level served as a better predictor for HBeAg-negative hepatitis compared with HBsAg level. However, in those with HBV-DNA level < 2000 IU/mL, a higher HBsAg level was associated with a higher risk of HBeAg-negative hepatitis (P = 0.015). Multivariate analysis showed the hazard ratio of HBsAg level ≥ 1000 IU/mL versus < 1000 IU/mL was 4.1 (95% confidence interval: 1.3-13.6). When using the end-point of active viral replication, HBsAg ≥ 1000 IU/mL remained as an independent risk factor, with a hazard ratio of 2.5 (95% confidence interval: 1.1-5.9). CONCLUSIONS In spontaneous HBeAg seroconverters with HBV-DNA level < 2000 IU/mL, HBsAg level ≥ 1000 IU/mL is associated with increased risks of HBeAg-negative hepatitis and active viral replication. Combining HBV-DNA < 2000 IU/mL and HBsAg level < 1000 IU/mL may be used to define minimal viral activity.
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Affiliation(s)
- Tai-Chung Tseng
- Division of Gastroenterology, Department of Internal Medicine, Taipei Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Taipei, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
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16
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Shen T, Yan XM. Hepatitis B virus genetic mutations and evolution in liver diseases. World J Gastroenterol 2014; 20:5435-41. [PMID: 24833874 PMCID: PMC4017059 DOI: 10.3748/wjg.v20.i18.5435] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 01/02/2014] [Accepted: 02/16/2014] [Indexed: 02/06/2023] Open
Abstract
Hepatitis B virus (HBV) belongs to the genus Orthohepadnavirus of the Hepadnaviridae family and is approximately 3.2 kb in length. Owing to a lack of proofreading capacity during reverse transcription and a high replication rate, HBV exhibits as quasispecies. To detect the genetic mutations of HBV, many methods with different sensitivities and throughputs were developed. According to documentary records, HBV mutation and evolution were important vial parameters in predicting disease progression and therapeutic outcome. In this review, we separately discussed the correlation between HBV genomic mutations in four open reading frames and liver disease progression. Since some of the results were controversial from different laboratories, it remains to be seen whether functional analyses will confirm their role in modifying the course of infection.
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Su TH, Liu CJ, Yang HC, Jeng YM, Cheng HR, Liu CH, Tseng TC, Ling TY, Chen PJ, Chen DS, Kao JH. Clinical significance and evolution of hepatic HBsAg expression in HBeAg-positive patients receiving interferon therapy. J Gastroenterol 2014; 49:356-62. [PMID: 23736797 DOI: 10.1007/s00535-013-0840-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 05/17/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Serum hepatitis B surface antigen (HBsAg) level is important in the management of chronic hepatitis B (CHB). However, it is unclear whether serum HBsAg reflects its expression in liver and the hepatic HBsAg evolution following interferon therapy. METHODS Forty-five HBeAg-positive CHB patients receiving interferon-based therapy within a randomized, controlled, multicenter study during 1998-1999 were included. The hepatic HBsAg expressions were categorized into cytoplasmic, inclusion, marginal and negative patterns by immunohistochemical staining. The HBsAg-positive hepatocytes were quantified by image-based cytometry and correlated to HBV serological and virological profiles for clinical implications. The evolution of hepatic HBsAg levels was analyzed among 22 patients with paired liver biopsies before and after interferon therapy, sequentially. RESULTS There was a positive correlation between pretreatment serum HBsAg and hepatic HBsAg levels (r = 0.67, P < 0.0001). The hepatic HBsAg expression pattern significantly evolved from cytoplasmic/inclusion pattern to marginal/negative pattern after interferon treatment. The serum HBV-DNA, HBsAg and hepatic HBsAg levels all decreased significantly after interferon therapy. Among 36 % patients with HBeAg loss after therapy, pretreatment hepatic HBsAg levels were significantly lower compared with those without HBeAg loss. After multivariate analysis, low pretreatment hepatic HBsAg levels rather than serum HBsAg titers were associated with a higher rate of HBeAg loss (OR: 4.97, 95 % CI: 1.12-22.00, P = 0.035). CONCLUSIONS The serum HBsAg level positively reflects the HBsAg level in liver which evolves significantly after interferon therapy. A lower hepatic HBsAg level is associated with HBeAg loss after interferon treatment. Hepatic HBsAg may have clinical significance in CHB patients receiving interferon treatment.
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Affiliation(s)
- Tung-Hung Su
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, 1 Chang-Te Street, Taipei, 10002, Taiwan
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18
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Hadziyannis E, Hadziyannis SJ. Hepatitis B surface antigen quantification in chronic hepatitis B and its clinical utility. Expert Rev Gastroenterol Hepatol 2014; 8:185-95. [PMID: 24417264 DOI: 10.1586/17474124.2014.876362] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Serum HBsAg levels have been quantified extensively in recent years with simple completely automated assays in the various phases of the natural course of chronic HBV infection, have been compared with cccDNA in the liver, with various markers of HBV replication and have been correlated with several viral, host and environmental variables. Low HBsAg levels in inactive carriers predict a spontaneous HbsAg loss. Quantification of HBsAg in serum at baseline and its decline under interferon-alfa based regimens, both in HBeAg-positive and HBeAg-negative CHB, provides important information on the prediction of sustained post-treatment outcomes and on subsequent HBsAg clearance. The value of HBsAg quantification in the monitoring of long term nucleos(t)ide analogue treatment of CHB and in the prediction of sustained response remains unclear. In this review, the most recent data regarding the overall clinical utility of HBsAg measurement in HBeAg-positive and -negative CHB and in their treatment, is critically presented.
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Affiliation(s)
- Emilia Hadziyannis
- Academic Department of Medicine, Hippokration Hospital, National and Kapodistrian University of Athens, 114 Vas. Sophias Ave, Athens 11529, Greece
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Ma JJ, Feng LY, Feng ZJ, Jiang HQ, Sun ZM, Zhao LM. Pathological characteristics of chronic hepatitis B in HBeAg-positive and HBeAg-negative patients: An analysis of 158 cases. Shijie Huaren Xiaohua Zazhi 2013; 21:1766-1771. [DOI: 10.11569/wcjd.v21.i18.1766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To find the differences in liver histopathology between HBeAg-positive and HBeAg -negative patients with chronic hepatitis B (CHB), and to analyze their relationship with clinical data.
METHODS: CHB patients ( n = 158) who were admitted to the Second Hospital of Hebei Medical University for a liver biopsy from January 2005 to December 2012 were enrolled. They were divided into an HBeAg-positive ( n = 86) and an HBeAg-negative group ( n = 72) based on the presence of HBeAg or not. Gender, age, alanine aminotransferase (ALT) and HBV DNA viral load were recorded and statistically analyzed with SPSS l3.0.
RESULTS: The age differed significantly between the HBeAg-positive group and HBeAg-negative group (t = -7.50, P < 0.01), although there was no statistically significant difference in sex ratio between the two groups (χ2 = 0.10, P > 0.05). A significant difference was noted in the constituent ratio of liver fibrosis stages between the two groups (χ2 = 20.79, P < 0.01). The fibrosis stage score in HBeAg-positive women was lower than that in men (1.48 ± 0.69 vs 2.09 ± 1.29, P < 0.05). For HBeAg-positive patients, both inflammation grade and fibrosis stage scores were significantly higher in the > 40 years age group than in the 30-40 years age group and < 30 years age group (2.93 ± 1.03 vs 2.09 ± 1.27, 2.16 ± 0.69; 2.67 ± 1.23 vs 1.86 ± 1.25, 1.65 ± 0.99, all P < 0.05). For HBeAg-negative patients, fibrosis stage score was significantly lower in the < 30 years age group than in the 30-40 years age group and > 40 years age group (1.57 ± 0.98 vs 2.73 ± 1.37, 3.03 ± 1.06, both P < 0.05). In the HBeAg-positive group, there was a positive correlation between age and inflammation grade or fibrosis stage score (r = 0.30, 0.34, both P < 0.01). In the HBeAg-negative group, there was also a positive correlation between age and inflammation grade or fibrosis stage score (r = 0.26, 0.34, both P < 0.05). In the HBeAg-positive group, ALT levels were positively correlated with inflammation grade or fibrosis stage score (r = 0.32, 0.24, both P < 0.05). In the HBeAg-negative group, ALT levels were positively correlated inflammation grade score (r = 0.33, P < 0.01). There was a significant difference in the constituent ratio of viral load between the two groups of patients (χ2 = 38.63, P < 0.01). The positive rate of HBV DNA was significantly higher in the HBeAg-positive group (73/86) than in the HBeAg-negative group (37/72). In the HBeAg-positive group, viral load was negatively correlated with inflammation grade score (r = -0.25, P < 0.05). In the HBeAg-negative group, viral load was positively correlated with inflammation grade or fibrosis stage score (r = 0.40, 0.43, both P < 0.05).
CONCLUSION: There is a certain correlation between gender, age, ALT and HBV DNA viral load and liver pathological changes in both HBeAg-positive and -negative CHB patients. Liver injury may sometimes be heavier in HBeAg-negative CHB patients than in HBeAg-positive CHB patients.
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