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


CONCLUSIONS
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.
Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong.
Wai-Kay
WK
Seto
Danny Ka-Ho
DK
Wong
James
J
Fung
Philip P C
PP
Ip
John Chi-Hang
JC
Yuen
Ivan Fan-Ngai
IF
Hung
Ching-Lung
CL
Lai
Man-Fung
MF
Yuen
D000293:Adolescent; D000328:Adult; D005260:Female; D006514:Hepatitis B Surface Antigens / Q000097:blood / Q000378:metabolism*; D006513:Hepatitis B e Antigens / Q000097:blood / Q000378:metabolism*; D019694:Hepatitis B, Chronic / Q000097:blood / Q000378:metabolism* / Q000473:pathology*; D006801:Humans; D008103:Liver Cirrhosis / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D055815:Young Adult
D006514:Hepatitis B Surface Antigens; D006513:Hepatitis B e Antigens