Clinical Characteristics and Correlation Analysis of Subjects with Chronic Hepatitis B Virus (HBV) Infection and Sustained Low Levels of Hepatitis B Surface Antigen (HBsAg)

Abstract

BackgroundThe aim of this study was to investigate the clinical characteristics of individuals with chronic hepatitis B virus (HBV) infection with persistent low levels of hepatitis B surface antigen (HBsAg) and to undertake a correlation analysis of the clinical characteristics.Material/MethodsThe study included 1,204 subjects with chronic HBV infection. Serum HBsAg, HBV envelope antigen (HBeAg), and HBV core antigen (HBcAg) levels were measured using the chemiluminescent microparticle immunoassay (CMIA) and the neutralization test. HBV DNA was measured using real-time fluorescence quantitative polymerase chain reaction (RT-FQ-PCR).ResultsThere were 1,023 subjects in the high-level HBsAg group (HBsAg level ≥10 IU/mL) and 181 subjects in the low-level HBsAg group (HBsAg level <10 IU/mL). In the low-level HBsAg group, the main serological pattern (93.37%) was HBsAg and HBeAg and HBcAg-positive (HBV-M2), and the asymptomatic carrier (ASC) status was 98.34%. The low-level HBsAg group had a lower HBV DNA-positive rate compared with the high-level HBsAg group (40.33% vs. 75.07%), with a normal distribution across all age groups (P>0.05). The low-level HBsAg group included an older age group. A low-level of HBsAg was positively correlated with a low level of replication of HBV DNA (r=0.452).ConclusionsThe findings of this study showed that individuals with chronic HBV infection and sustained low-levels of HBsAg were an older population and had a lower level of replicating HBV DNA when compared with individuals with high levels of HBsAg, and the majority (93.7%) were also HBsAg and HBeAg and HBcAg-positive.

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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.…”

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

Research Progress on the Mechanism of Persistent Low-Level HBsAg Expression in the Serum of Patients with Chronic HBV Infection

“…At present, more and more studies have found that some patients with chronic HBV infection have sustained low-level expression of HBsAg, which shows an inactive HBsAg-carrying state, that is, most of them are chronic asymptomatic HBV carriers (ASCs) [ 11 ], which is different from HBeAg-positive immune-tolerant phase. The clinical manifestations of HBeAg-positive immune-tolerant phase are generally strong HBsAg, HBeAg, and HBcAb positive, and the level of HBV-DNA is also high.…”

Analysis of S gene characteristic sequences and changes in properties of protein expression in HBV ASCs with low-level HBsAg

“…Based on the interaction between the virus and host immunity, HBV infection presents a variety of clinical manifestations, including acute hepatitis, chronic hepatitis, liver dysfunction, liver cirrhosis and hepatocellular carcinoma ( 6 ). Some asymptomatic HBV-infected people have persistent low-level expression of HBsAg, and the literature reports show that the proportion is as high as 15.03–21.1% ( 7 , 8 ). However, some patients with low-levels expression of HBsAg often miss detection in the process of clinical detection, which undoubtedly does not increase the risk of HBV transmission and poses a serious threat to the safety of clinical blood transfusion.…”