Peritoneoscopic liver biopsy findings in asymptomatic chronic HBsAg carriers with normal liver function tests and no hepatomegaly

Serum HBeAg and HBV DNA levels are not always proportional and only high levels of HBeAg most likely correlate with high levels of HBV DNA: A community-based study

This study aimed to investigate the correlation between quantitative hepatitis B e antigen (HBeAg) and hepatitis B virus (HBV) DNA levels, and to determine whether semiquantitative measurement of HBeAg can indicate the extent of HBV replication in HBeAg-positive subjects in the immune tolerant phase.A cross-sectional, community-based survey was carried out in 12 communities of 2 counties in Zhejiang Province, China. A panel of 788 HBeAg-positive subjects was divided into 4 groups according to HBV DNA level.Groups I (n = 111), II (n = 91), III (n = 124), and IV (n = 462) had HBV DNA levels below 10 copies/mL (PCR undetectable), between 10 and 10 copies/mL (PCR detectable), between 10 and 2 × 10 copies/mL (hybridization detectable), and >2 × 10 copies/mL, respectively. The HBeAg level correlated well with the HBV DNA level (R = 0.658; P < .01) on a log scale. The average HBeAg level in group IV was significantly higher than those in the other 3 groups, and the best HBeAg cut-off value for differentiating group IV from the other 3 groups was 768 S/CO, with a sensitivity of 94.4% and specificity of 91.1%.Semiquantification of HBeAg could indicate a relative HBV DNA level in HBeAg-positive subjects in the immune tolerant phase.

Globulin-platelet model predicts minimal fibrosis and cirrhosis in chronic hepatitis B virus infected patients

AIM: To establish a simple model consisting of the routine laboratory variables to predict both minimal fibrosis and cirrhosis in chronic hepatitis B virus (HBV)-infected patients.

METHODS: We retrospectively investigated 114 chronic HBV-infected patients who underwent liver biopsy in two different hospitals. Thirteen parameters were analyzed by step-wise regression analysis and correlation analysis. A new fibrosis index [globulin/platelet (GP) model] was developed, including globulin (GLOB) and platelet count (PLT). GP model = GLOB (g/mL) × 100/PLT (× 10⁹/L). We evaluated the receiver operating characteristics analysis used to predict minimal fibrosis and compared six other available models.

RESULTS: Thirteen clinical biochemical and hematological variables [sex, age, PLT, alanine aminotransferase, aspartate aminotransferase (AST), albumin, GLOB, total bilirubin (T.bil), direct bilirubin (D.bil), glutamyltransferase, alkaline phosphatase, HBV DNA and prothrombin time (PT)] were analyzed according to three stages of liver fibrosis (F0-F1, F2-F3 and F4). Bivariate Spearman’s rank correlation analysis showed that six variables, including age, PLT, T.bil, D.bil, GLOB and PT, were correlated with the three fibrosis stages (FS). Correlation coefficients were 0.23, -0.412, 0.208, 0.220, 0.314 and 0.212; and P value was 0.014, < 0.001, 0.026, 0.018, 0.001 and 0.024, respectively. Univariate analysis revealed that only PLT and GLOB were significantly different in the three FS (PLT: F = 11.772, P < 0.001; GLOB: F = 6.612, P = 0.002). Step-wise multiple regression analysis showed that PLT and GLOB were also independently correlated with FS (R² = 0.237). By Spearman’s rank correlation analysis, GP model was significantly correlated with the three FS (r = 0.466, P < 0.001). The median values in F0-F1, F2-F3 and F4 were 1.461, 1.720 and 2.634. Compared with the six available models (fibrosis index, AST-platelet ratio, FIB-4, fibrosis-cirrhosis index and age-AST model and age-PLT ratio), GP model showed a highest correlation coefficient. The sensitivity and positive predictive value at a cutoff value < 1.68 for predicting minimal fibrosis F0-F1 were 72.4% and 71.2%, respectively. The specificity and negative predictive value at a cutoff value < 2.53 for the prediction of cirrhosis were 84.5% and 96.7%. The area under the curve (AUC) of GP model for predicting minimal fibrosis and cirrhosis was 0.762 [95% confidence interval (CI): 0.676-0.848] and 0.781 (95% CI: 0.638-0.924). Although the differences were not statistically significant between GP model and the other models (P all > 0.05), the AUC of GP model was the largest among the seven models.

CONCLUSION: By establishing a simple model using available laboratory variables, chronic HBV-infected patients with minimal fibrosis and cirrhosis can be diagnosed accurately, and the clinical application of this model may reduce the need for liver biopsy in HBV-infected patients.

Natural history of chronic HBV infection: special emphasis on the prognostic implications of the inactive carrier state versus chronic hepatitis

The evaluation of the natural history of chronic hepatitis B virus (HBV) infection requires the precise definition of the various clinical conditions that can be encountered (i.e. inactive carrier state or subject with liver disease activity). This can be achieved by repeat monitoring of ALT, serum HBV-DNA levels (over a period of at least 1 year, according to international guidelines) and/or evaluation of HBsAg titre. Liver biopsy may offer additional information although it is not mandatory. Overall, the natural history of the true inactive carrier is benign: reactivation of hepatitis, especially in Western countries, is rare and is usually due to co-factors (like alcohol or drugs); spontaneous HBsAg loss is frequent (around 1% per year) and HCC development rare. On the other hand, in patients with chronic hepatitis B or cirrhosis, the risk of reactivation, of HCC development and of liver-related mortality is much higher, especially in Eastern countries, and should therefore lead to antiviral therapy.

Comparative analysis of peripheral T-cell subsets and liver histopathology in asymptomatic hepatitis B virus carriers

AIM: To investigate the influences of serum hepatitis B virus DNA and HBeAg levels on the function of cellular immunity and the changes of liver histopathology in asymptomatic chronic HBV carriers, and to explore the mechanism involved in it.

METHODS: Peripheral T-cell subsets were determined in 109 asymptomatic chronic HBV carriers and 40 normal controls by flow cytometry. Of the 109 carriers, histopathological examinations were performed in 28 ones. HBV markers were detected by enzyme linked immunosorbent assay (ELISA), and serum HBV DNA levels were measured by polymerase chain reaction (PCR).

RESULTS: The rates of CD3+ and CD4+ cells and the value of CD4+/CD8+ were significantly reduced in HBV carriers as compared with those in the normal controls (67.2%±9.0% vs 71.0%±3.5%, P < 0.05; 33.1%±6.6% vs 40.3%±2.8%, P < 0.001; 1.1%±0.36 vs 2.01±0.19, P < 0.001), and the rate of CD8+ cells was significantly increased (33.8±8.4% vs 20.2±1.9%, P < 0.001). The rates of CD3+ cells in HBV DNA(+) and in HBeAg(+) carriers showed no significant difference from those of HBV DNA(-) and HBeAg(-) carriers, respectively; However, the rate of CD4+ cells (31.2±6.3% vs 37.2±5.4%, P < 0.001; 31.0±6.0% vs 35.8±6.5%, P < 0.001) and the value of CD4+/CD8+ (0.91±0.32 vs 1.35±0.26, P < 0.001; 0.89±0.30 vs 1.26±0.33, P < 0.001) were markedly decreased, while the rate of CD8+ cells (36.7±8.4% vs 27.9±4.2%, P < 0.001; 37.3±8.4% vs 29.5±6.0%, P < 0.001) was increased in HBV DNA(+) and in HBeAg(+) carriers. The pathological changes that reached G1S1 stage covered a percentage of 68.8% in HBV DNA(+) carriers, which was significantly higher than that (16.7%) in HBV DNA(-) ones (c² = 5.57, P < 0.01). The rate of CD3+ cells was notably reduced (F = 2.919, P < 0.05) in G1S1 carriers as compared with that in G1S0 ones, but the rate of CD4+ cells showed no significant difference between them. Compared with those in G1S0 carriers, the rates of CD3+ and CD4+ cells and the value of CD4+/CD8+ tended to reduce, but the rate of CD8+ cells was tended to increase in G2S1 ones.

CONCLUSION: HBV infection can lead to disorder of cellular immunity in chronic HBV carriers, and the disorder and liver damages can be promoted by the increased serum levels of HBV DNA and HBeAg.

Histopathology and clinical correlates of end-stage hepatitis B cirrhosis: a possible mechanism to explain the response to antiviral therapy

In chronic liver disease associated with histological necroinflammation, clinical severity is frequently greater in those with higher grades of activity. Conventional wisdom assumes that necroinflammation is mild or absent in patients with end-stage hepatitis B virus (HBV) cirrhosis due to the frequent presence of mildly elevated aminotransferase levels, the absence of hepatitis B e antigen (HBeAg), and low or undetectable HBV deoxyribonucleic acid (DNA) levels. However, a histopathologic analysis of such patients has not been undertaken. The aims of this study were 1) to assess severity and histological features of inflammation, 2) to correlate the severity of inflammation with biochemical and virologic parameters, and 3) to define the relationship between inflammation and clinical severity in explanted livers from patients undergoing liver transplantation for HBV cirrhosis. Characteristics of 34 consecutive patients undergoing liver transplantation for HBV cirrhosis were correlated with inflammation and immunohistological findings in the explanted livers. High-grade inflammation (grades 3 and 4) was found in many cases (47.1% interface hepatitis; 14.8% lobular inflammation; and 20.6% portal inflammation). The presence of positive cytoplasmic staining for hepatitis B core antigen (HBcAg) was associated with grade 3 or 4 interface hepatitis (P = .046) and lobular hepatitis (P = .005). There was no correlation between inflammatory activity and age, Asian ethnicity, aminotransferase levels, total bilirubin levels, HBeAg seropositivity, and detectable HBV DNA level. Patients with high-grade inflammation had greater degrees of hepatic decompensation. In conclusion, high-grade inflammation is common in end-stage HBV cirrhosis, but it is not readily detected by biochemical and virologic parameters. High-grade inflammation is associated with a greater degree of hepatic decompensation.