Quantitative analysis of HBsAg, IgM anti-HBc and anti-HBc avidity in acute and chronic hepatitis B

Rodella, Anna; Galli, Claudio; Terlenghi, Luigina; Perandin, Francesca; Bonfanti, Carlo; Manca, N.

doi:10.1016/j.jcv.2006.06.011

Cited by 90 publications

(91 citation statements)

References 27 publications

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“…Rodella et al 82 by quantitative assay, found IgM antiHBc antibodies were positive in 32.85% in patients with chronic hepatitis B though at lower levels than AVH-B. They found that average sample/cutoff (S/CO) value of >10 for IgM anti-HBc identified AVH-B while in CHB-AE the S/CO values were <10.…”

Section: Igm Anti Hbcmentioning

confidence: 98%

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Acute Exacerbation of Chronic Hepatitis B: The Dilemma of Differentiation from Acute Viral Hepatitis B

Puri

2013

Journal of Clinical and Experimental Hepatology

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Exacerbations of chronic hepatitis B are common in endemic countries. Acute exacerbation of chronic hepatitis B virus (CHB-AE) causing derangement of liver functions may be seen in a flare of HBV in immune clearance phase or as a reactivation of HBV in patients with inactive or resolved HBV infection. While reactivation of HBV is usually seen in HBsAg positive patients, it is being increasingly recognized in patients with apparently resolved HBV infection who do not have HBsAg in serum but have IgG antibody to core antigen (anti-HBc) in the serum, especially so in patients on chemotherapy, immunosuppressive therapy or undergoing hematopoietic stem cell transplantation. In an icteric patient who is HBsAg positive, it may be difficult to differentiate CHB-AE from acute viral hepatitis B (AVH-B). Both may have similar clinical presentation and even IgM anti-HBc, the traditional diagnostic marker of AVH-B, may also appear at the time of exacerbation of CHB. The differentiation between CHB-AE and AVH-B is important not only for prognostication but also because management strategies are different. Most cases of AVH-B will resolve on their own, HBsAg clearance is achieved spontaneously in 90-95% of adults and treatment is rarely indicated except in the few with severe/fulminant disease. In contrast, in CHB-AE, the onset of jaundice may lead to decompensation of liver disease and treatment is warranted. The mechanisms of acute exacerbation and the differentiating features between AVH-B and CHB-AE are reviewed. ( J CLIN EXP HEPATOL 2013;3:301-312)

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Section: Igm Anti Hbcmentioning

confidence: 98%

“…The study by Rodella 82 has defined AVH-B based on symptoms and IgM anti-HBc and ALT values more than 8 times above normal. However, it is known that IgM anti-HBc can be positive in CHB-AE; and that symptoms and ALT levels may not exclude CHB-AE.…”

Section: Interpreting the Data On Chronic Hepatitis B With Acute Exacmentioning

confidence: 99%

Acute Exacerbation of Chronic Hepatitis B: The Dilemma of Differentiation from Acute Viral Hepatitis B

Puri

2013

Journal of Clinical and Experimental Hepatology

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“…A correlation between the levels of circulating HBsAg and the levels of intrahepatic HBV cccDNA has led to renewed interest in the development of sensitive quantitative assays for HBsAg as well as HBeAg [32,33]. Although population distributions have been defined for patients having chronic hepatitis B [32][33][34][35][36], it is clear that much more relevant data can be obtained than by standard qualitative serology.…”

Section: Quantitative Hbeag and Hbsag Assaysmentioning

confidence: 99%

“…Although population distributions have been defined for patients having chronic hepatitis B [32][33][34][35][36], it is clear that much more relevant data can be obtained than by standard qualitative serology. Thus, the use of quantitative HBeAg and HBsAg assays may allow fine-tuning of treatment protocols.…”

Section: Quantitative Hbeag and Hbsag Assaysmentioning

confidence: 99%

“…Although uncommon, it remains the ultimate goal in the management of chronic hepatitis B. HBsAg titers have been shown to correlate with intrahepatic levels of cccDNA and serum levels of HBV DNA in the different phases of disease [32,33]. Furthermore, HBsAg titer appears to decline along with decline of cccDNA during treatment [25,27].…”

Section: Quantitative Hbsag Assaysmentioning

confidence: 99%

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New developments in HBV molecular diagnostics and quantitative serology

Bowden

Thompson

2008

Hepatol Int

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New standardized assays for the quantification of hepatitis B virus (HBV) DNA have yielded insights into the association of HBV DNA levels with the relative risk of developing liver disease. Quantification of HBV DNA has also played a role in the management of chronic hepatitis B by allowing criteria to be established for determining patient eligibility for antiviral therapy, monitoring response, and identifying the development of resistance. In addition to serum HBV DNA levels, the HBV genotype may influence disease progression and response to therapy. However, many of the studies that have included genotype assessment do not compare across the range of genotypes, and current management guidelines do not incorporate genotype determination. More recently, quantitative assays for intrahepatic HBV replicative intermediates, as well as hepatitis B e antigen and hepatitis B surface antigen, indicate that these factors may have promise in identifying patients likely to respond to treatment. Additional work is needed to standardize and validate these assays before they can be considered to be of true diagnostic value. A wide variety of research techniques are being used to investigate chronic hepatitis B. Further evaluation is needed to decide which will have the greatest clinical applicability.

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