title: Historic and current hepatitis B viral DNA and quantitative HBsAg level are not associated with cirrhosis in non-Asian women with chronic hepatitis B.
abstract: BACKGROUND
  Some studies done in Asian patients have shown that serum levels of hepatitis B virus (HBV) DNA predict the development of cirrhosis. However, it is unclear whether this also applies for non-Asian patients. This study investigated historic and current HBV DNA and quantitative hepatitis B surface antigen (HBsAg) levels as predictors of cirrhosis in non-Asian women with chronic HBV.
  
  
  METHODS
  A retrospective cohort study of non-Asian women with chronic HBV was performed. Among other variables, HBV DNA and quantitative HBsAg levels were measured in stored historic serum samples obtained during pregnancy (period 1990-2004) and current serum samples (period 2011-2012) to determine any association with liver cirrhosis by liver stiffness measurement (LSM).
  
  
  RESULTS
  One hundred and nineteen asymptomatic, treatment-naïve non-Asian women were included; the median number of years between the historic sample and the current sample was 17 (interquartile range (IQR) 13-20). The median historic log HBV DNA and quantitative log HBsAg levels were 2.5 (IQR 1.9-3.4) IU/ml and 4.2 (IQR 3.6-4.5) IU/ml, respectively. LSM diagnosed 14 patients (12%) with F3-F4 fibrosis, i.e. stiffness >8.1kPa. No association of cirrhosis was found with historic HBV DNA (relative risk (RR) 0.34, 95% confidence interval (CI) 0.05-2.44) or with the quantitative HBsAg level (HBsAg level >1000 IU/ml, RR 0.35, 95% CI 0.11-1.11). Multivariable analysis identified alcohol consumption (odds ratio (OR) 6.4, 95% CI 1.3-30.1), aspartate aminotransferase >0.5 times the upper limit of normal (OR 15.4, 95% CI 1.9-122.6), and prothrombin time (OR 12.0, 95% CI 1.2-120.4), but not HBV DNA or quantitative HBsAg level, to be independent predictors of the presence of cirrhosis.
  
  
  CONCLUSIONS
  Neither historic nor current HBV DNA or the quantitative HBsAg level is associated with the development of HBV-related cirrhosis in non-Asian women.
authors.affiliation: Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht (UMCU), Heidelberglaan 100, PO Box 85500, F02.126, 3508 GA Utrecht, the Netherlands. Electronic address: s.harkisoen@umcutrecht.nl.
authors.forename: S
authors.initials: S
authors.lastname: Harkisoen
authors.affiliation: Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht (UMCU), Heidelberglaan 100, PO Box 85500, F02.126, 3508 GA Utrecht, the Netherlands.
authors.forename: J E
authors.initials: JE
authors.lastname: Arends
authors.affiliation: Department of Infectious Diseases, Public Health Service of Amsterdam (GGD), Amsterdam, the Netherlands; Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Centre, Amsterdam, the Netherlands.
authors.forename: J A R
authors.initials: JA
authors.lastname: van den Hoek
authors.affiliation: Department of Infectious Diseases, Public Health Service of Amsterdam (GGD), Amsterdam, the Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Whelan
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Centre Utrecht (UMCU), Utrecht, the Netherlands.
authors.forename: K J
authors.initials: KJ
authors.lastname: van Erpecum
authors.affiliation: Department of Medical Microbiology, University Medical Centre Utrecht (UMCU), Utrecht, the Netherlands.
authors.forename: G J
authors.initials: GJ
authors.lastname: Boland
authors.affiliation: Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht (UMCU), Heidelberglaan 100, PO Box 85500, F02.126, 3508 GA Utrecht, the Netherlands.
authors.forename: A I M
authors.initials: AI
authors.lastname: Hoepelman
mesh_terms: D000328:Adult; D044466:Asian People; D015331:Cohort Studies; D004279:DNA, Viral / Q000097:blood*; D005260:Female; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D006515:Hepatitis B virus / Q000235:genetics*; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000821:virology; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000821:virology*; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens
keywords: Cirrhosis; Hepatitis B; Non-Asian; Viral load