A large-scale analysis study on the clinical and viral characteristics of hepatitis B infection with concurrence of hepatitis B surface or E antigens and their corresponding antibodies

Abstract

ABSTRACT. Concurrent detection of hepatitis B surface antigen (HBsAg) and anti-HBs antibody or hepatitis B surface E antigen (HBeAg) and anti-HBe antibody in patients with chronic hepatitis B (CHB) infection is well established. However, the clinical implications of these proteins remain largely unknown. In this study, demographic, clinical, and laboratory data from 124,865 patients with chronic CHB infection were analyzed. Viral genotypes were determined by nested polymerase chain reaction. A chemiluminescent assay was applied to measure HBsAg, HBsAb, HBeAg, HBeAb, and HBcAb in sera. Among 124,865 patients with CHB infection, 324 (0.3%) were concurrently positive for HBsAg and anti-HBs, and 206 (0.2%) were concurrently positive for HBeAg and anti-HBe. The HBeAg+/anti-HBe+ group was composed of younger patients (P < 0.05). Subgenotype B2 was prevalent in HBV patients concurrently positive for HBeAg and anti-HBe, while HBV patients positive for both HBsAg and anti-HBs exhibited the C2 subgenotype. Among 530 concurrent patients, 126 (39%) HBsAg+/ anti-HBs+ patients were in the low-replication phase, and 62 (19%) were in the reactivation phase; 87 (42%) HBeAg+/anti-HBe+, and 19 (6%) HBsAg+/anti-HBs+ patients were in the immune clearance phase. In this large-scale analysis, the clinical and viral characteristics of HBV infections with concurrent HBs Ag/antibody or HBe Ag/antibody presentations have been examined, and the results may contribute to the diagnosis and treatment of CHB patients.

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“…A small numbers of the study cohort showed co-existence of HBs Ag/Hbs Ab reactive probably on a transitional state to clear the virus or probably suggesting a selection of immune escape mutants during the disease period, a finding previously reported. 32,[34][35][36][37] Individuals with immune tolerance CHBV could not be identified within the study cohort, in agreement with recent reports that challenged the early concepts of existence of this immune pathologic phase. Recent evidence showed that subtle liver damage in the presence of normal aminotransferases levels exits in CHBV individuals.…”

“…33 Cheng and colleagues 34 reported that the majority of their patients were Hbs Ag/HBe Ag/Hbc Ag reactive, a finding that is discordant with our findings. 34 Hbe Ag/HBe Ab non-reactivity was seen in the majority of our cohort, this probably indicates disease inactivity or immune exhaustion that has been well-documented in CHBV. Furthermore, Hbe Ag/HBe Ab non-reactivity could mean mutations in the pre-core or core regions of the viral genome.…”

“…Recent evidence showed that subtle liver damage in the presence of normal aminotransferases levels exits in CHBV individuals. 10,32,[34][35][36][37]…”

Factors associated with disease progression and viral replication in patients with chronic hepatitis B virus infection

“…Hepatitis B e antigen (HBeAg) is a critical indicator to determine the severity of the disease and it is associated with the activity of viral replication and infectivity (22). In addition, HBeAg analysis is useful for predicting seroconversion and disease progression (23).…”

Establishment of an analysis model based on measurement of hepatitis B viral infection serum markers

“…The host immune response causes both hepatocellular damage and clearance of viral antigen [4–6]. Serum markers of HBV infection might help with assessment of various issues such as prognosis [7–9].…”