Abbreviations: aa, amino acid; ALT, alanine aminotransferase; AUC, area under the curve; CHB, chronic hepatitis B; CI, confidence interval; ELISA, enzyme-linked immunosorbent assay;HBeAg, hepatitis B e antigen; HBs, hepatitis B surface (protein); HBsAg, hepatitis B surface antigen; HBV, hepatitis B virus; LAM, lamivudine; LLOQ, lower limit of quantification;PegIFN, peginterferon alfa-2a; qHBsAg, quantitative hepatitis B surface antigen; ROC, receiver operating characteristic; SC, seroconversion; SHBs/MHBs/LHBs, small/middle/large hepatitis B surface (protein); SVP, subviral particle. Abstract Background & Aims: Hepatitis B virus (HBV) contains three viral surface proteins, large, middle and small hepatitis B surface protein (LHBs, MHBs, SHBs). Proportions of LHBs and MHBs are lower in patients with inactive vs active chronic infection. Interferon alfa may convert hepatitis B e antigen (HBeAg)-positive chronic hepatitis B (CHB) to an inactive carrier state, but prediction of sustained response is unsatisfactory. The aim of this study was to test the hypothesis that quantification of MHBs and LHBs may allow for a better prognosis of therapeutic response than total hepatitis B surface antigen (HBsAg) concentration. Methods: Hepatitis B surface proteins were measured before and during peginterferon alfa-2a therapy in serum from 127 Asian patients with HBeAg-positive CHB. Sustained response was defined as HBeAg seroconversion 24 weeks post-treatment.Results: Mean total HBs levels were significantly lower in responders vs nonresponders at all time points (P < .05) and decreased steadily during the initial 24 weeks treatment (by 1.16 vs 0.86 ng/mL in responders/nonresponders respectively) with unchanged relative proportions. Genotype B had a two-fold higher proportion of LHBs than genotype C (13% vs 6%). HBV DNA, HBeAg, HBsAg and HBs protein levels predicted response equally well but not optimally (area under the receiver operating characteristic curve values >0.70).
Conclusions:Hepatitis B surface protein levels differ by HBV genotype. However, quantification of HBs proteins has no advantage over the already established HBsAg assays to predict response to peginterferon alfa-2a therapy in HBeAg-positive patients.
K E Y W O R D SHBs proteins, HBsAg, peginterferon alfa-2a, predictors of response, subviral particles | 325 RINKER Et al.