High hepatitis B surface antigen levels predict insignificant fibrosis in hepatitis B e antigen positive chronic hepatitis B

PLoS One. 2012;7(8):e43087. doi: 10.1371/journal.pone.0043087. Epub 2012 Aug 20.

Abstract

Introduction: There is no data on the relationship between hepatitis B surface antigen (HBsAg) levels and liver fibrosis in hepatitis B e antigen (HBeAg)-positive patients with chronic hepatitis B (CHB).

Methods: Serum HBsAg and HBV DNA levels in HBeAg-positive CHB patients with liver biopsies were analyzed. The upper limit of normal (ULN) of alanine aminotransferase (ALT) was 30 and 19 U/L for men and women respectively. Histologic assessment was based on Ishak fibrosis staging for fibrosis and Knodell histologic activity index (HAI) for necroinflammation.

Results: 140 patients (65% male, median age 32.7 years) were recruited. 56 (40%) had ALT ≤2×ULN. 72 (51.4%) and 42 (30%) had fibrosis score ≤ 1 and necroinflammation grading ≤ 4 respectively. Patients with fibrosis score ≤ 1, when compared to patients with fibrosis score >1, had significantly higher median HBsAg levels (50,320 and 7,820 IU/mL respectively, p<0.001). Among patients with ALT ≤2×ULN, serum HBsAg levels achieved an area under receiver operating characteristic curve of 0.869 in predicting fibrosis score ≤ 1. HBsAg levels did not accurately predict necroinflammation score. HBsAg ≥ 25,000 IU/mL was independently associated with fibrosis score ≤ 1 (p=0.025, odds ratio 9.042).Using this cut-off HBsAg level in patients with ALT ≤2×ULN, positive and negative predictive values for predicting fibrosis score ≤ 1 were 92.7% and 60.0% respectively. HBV DNA levels had no association with liver histology.

Conclusion: Among HBeAg-positive patients with ALT ≤2×ULN, high serum HBsAg levels can accurately predict fibrosis score ≤ 1, and could potentially influence decisions concerning treatment commencement and reduce the need for liver biopsy.

MeSH terms

  • Adolescent
  • Adult
  • Female
  • Hepatitis B Surface Antigens / blood
  • Hepatitis B Surface Antigens / metabolism*
  • Hepatitis B e Antigens / blood
  • Hepatitis B e Antigens / metabolism*
  • Hepatitis B, Chronic / blood
  • Hepatitis B, Chronic / metabolism*
  • Hepatitis B, Chronic / pathology*
  • Humans
  • Liver Cirrhosis / metabolism*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Young Adult

Substances

  • Hepatitis B Surface Antigens
  • Hepatitis B e Antigens

Grants and funding

The authors have no support or funding to report.