Can quantitative hepatitis B surface antigen levels predict the severity of liver disease in genotype E Patients?

Abstract

SummaryThe utility of quantitative Hepatitis B surface antigen (qHBsAg) level as a marker of chronic hepatitis B (CHB)-related liver damage is not fully delineated, but is becoming increasingly relevant. Quantitative HBsAg levels are linked with progression of liver disease in HBeAg-negative genotype B and C patients, but it is not clear whether this is consistent across all HBV genotypes. In this single-centre, cross-sectional observational study, we evaluated whether qHBsAg levels can predict the severity of liver disease in genotype E patients. Demographic characteristics, viral, biochemical markers and qHBsAg levels were assessed at time of liver biopsy [all HBV DNA>2000 IU/mL and/or abnormal alanine transaminase (ALT)]. Patients were divided into three groups according to the severity of fibrosis on biopsy: mild (F0-1), moderate (F2-4), severe (F5-6) liver disease and into two groups according to the NI grading, low (NI 0-3) and high inflammation (NI ≥4). A total of 259 HBeAg-negative CHB treatment-naive genotype E patients were studied. The median age of this cohort was 38 years, and 61% were males. Advanced (severe) fibrosis patients had higher ALT, HBV DNA, and lower HBsAg level and qHBsAg/DNA ratio. Patients with NI ≥4 had higher ALT, HBV DNA, but lower qHBsAg/DNA ratio. There was no correlation between HBsAg and HBV DNA levels. Quantitative HBsAg levels were lower in more advanced liver fibrosis.There was no correlation between qHBsAg and HBV DNA levels. This may reflect discordance between viral replication and transcriptional activity or differential HBsAg expression in HBeAg-negative genotype E patients with advanced liver disease.

Clinical utility of quantifying hepatitis B surface antigen in African patients with chronic hepatitis B

“…As observed in other studies, 19‐21,29 we found a poor correlation between qHBsAg levels and HBV viral load, especially in HBeAg‐negative subjects. In West African HBV‐infected patients with viral load ≥2,000 IU/ml and raised ALT level, Chakrabarty et al found lower qHBsAg levels in patients with advanced liver fibrosis 21 . We also found low level of HBsAg in subjects with cirrhosis but no correlation was observed between LSM and qHBsAg levels in our study (data not shown).…”

“…Unfortunately, in contrast to previous findings, 14,30 qHBsAg levels failed in our study to accurately identify subjects in this phase. This could be explained by relatively high levels of qHBsAg levels of subjects with HBeAg‐negative chronic infection in our study (median 4526.1 IU/ml (460.2–13,000) despite very low median HBV viral load 33.50 IU/ml (3.79–154.07)) as reported in previous African studies 20,21 . Asian and Western studies 14,16 reported much lower qHBsAg levels in their population of inactive chronic carriers.…”

“…To the best of our knowledge, the utility of qHBsAg has never been examined in HBV‐infected African patients, so far. To date, only two studies analysed the levels of qHBsAg in African subjects; one study from Senegal assessed the fluctuation of qHBsAg levels in 87 HBV‐infected patients with normal ALT level 20 but did not examine whether qHBsAg levels could help classifying the phase of natural history of chronic HBV infection; another study conducted in the UK assessed the qHBsAg levels in 259 genotype E patients born in West Africa, but only included patients with a viral load above 2,000 IU/ml and raised ALT level 21 …”

Quantitative HBsAg: Not helpful to evaluate fibrosis in HBeAg-negative chronic hepatitis B patients

“…The authors concluded that disease stratification is not feasible with qHBsAg levels, with results being in conformity with other studies in patients with HBeAg-ve where higher qHBsAg levels did not identify significant fibrosis. [1314]…”

Quantitative HBsAg levels do not identify hepatic fibrosis in HBeAg-negative chronic hepatitis B patients

“…However, our results show that this disease stratification is not feasible with qHBsAg levels, with results being in conformity with other studies in HBeAg-negative patients where higher qHBsAg levels did not identify significant fibrosis. [192021]…”