Hepatitis B surface antigen levels after hepatitis B e-antigen seroclearance: a longitudinal follow-up study.
OBJECTIVE
The role of quantitative hepatitis B surface antigen (HBsAg) after hepatitis B e-antigen (HBeAg) seroclearance is not well defined. To determine the role of HBsAg levels in predicting significant viremia and hepatitis flares after HBeAg seroclearance.


METHODS
A total of 228 chronic hepatitis B patients with spontaneous HBeAg seroclearance were included. Patients were followed up regularly at 3-6 monthly intervals with routine liver biochemistry and hepatitis B serology. Levels of HBV DNA and HBsAg were measured at yearly intervals for up to 5 years after HBeAg seroclearance.


RESULTS
The median log HBsAg and HBV DNA level after HBeAg seroclearance was 3.52 IU/ml and 4.13 IU/ ml respectively, with no significant correlation observed between them (P = 0.572). The HBV DNA at HBeAg seroclearance was 4.13 log IU/ml, compared with 3.12 log IU/ml after 5 years (P < 0.001). No significant change was observed for HBsAg levels (P = 0.991). Hepatitis B flares occurred in 76 (33.3%) patients. Patients who developed hepatitic flares compared with those without hepatitic flares were older (40 vs. 36 years, P = 0.001), had a higher HBV DNA at the time of HBeAg seroclearance (4.70 vs. 3.77 log IU/ml, P =< 0.001), and more likely to be males (42.7% vs. 23.4%, P = 0.002) respectively. There was no difference in HBsAg levels between those with and without hepatitis flare (3.54 vs. 3.52 log IU/ml respectively, P = 0.555).


CONCLUSIONS
HBV DNA levels, but not HBsAg levels, after HBeAg seroclearance were associated with subsequent significant viremia and hepatitic flares. Male gender and older age was associated with significant viremia.
Department of Medicine, The University of Hong Kong, Hongkong, China; State Key Laboratory for Liver Research, The University of Hong Kong, Hongkong, China; Liver Transplant Centre, Queen Mary Hospital, Hongkong, China.
James
J
Fung
Wai-Kay
WK
Seto
Danny Ka-ho
DK
Wong
Ching-lung
CL
Lai
Man-fung
MF
Yuen
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D004279:DNA, Viral / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D006513:Hepatitis B e Antigens / Q000097:blood*; D006515:Hepatitis B virus; D019694:Hepatitis B, Chronic / Q000188:drug therapy*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012698:Serologic Tests; D012737:Sex Factors; D014766:Viremia / Q000175:diagnosis; D055815:Young Adult
D000998:Antiviral Agents; D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D006513:Hepatitis B e Antigens
HBeAg; HBsAg level; chronic hepatitis B; flare; hepatitis