title: Coexistence of circulating HBsAg and anti-HBs antibodies in chronic hepatitis B carriers is not a simple analytical artifact and does not influence HBsAg quantification.
abstract: BACKGROUND
  Presence at the same time of HBsAg and anti-HBs antibodies (HBsAg/Ab) is an entity sometimes encountered in chronic hepatitis B (CHB) carriers.
  
  
  OBJECTIVE
  This study was designed to characterize such serological profiles and to assess the reliability of serological marker quantification by three commercially available assays in this setting.
  
  
  METHODS
  Among 2578 CHB identified patients, 129 (5%) had an HBsAg/Ab profile as determined by Abbott Architect. After exclusion of co-infections (HIV, HCV, HDV), HBV reactivation or HBIg treatment, 101 samples from 62 patients were tested for HBsAg and anti-HBs quantification using Architect, DiaSorin Liaison-XL and Roche Modular-Cobas. Influence of genotype and HBsAg variants was studied in 31 samples with HBV replication.
  
  
  RESULTS
  HBsAg detection was confirmed with the 3 techniques for 98% (n = 99) of the samples while the HBsAg/Ab profile was concordant between all techniques for 65% of them. The overall correlation between the 3 HBsAg quantification techniques was good (R(2): 0.94-0.97). The median HBsAg concentration was comparable for the 99 samples whatever the used technique but a bias of -0.11 and 0.02 log IU/mL were noticed for DiaSorin and Roche compared to Abbott, respectively. Anti-HBs quantifications were poorly correlated between techniques with major discrepancies observed. Genotype and substitutions within the "a" determinant showed an impact on HBsAg quantification.
  
  
  CONCLUSIONS
  The double HBsAg/Ab profile is not an analytical artifact and is confirmed on all commercially available techniques. While such profile does not influence HBsAg quantification, differences of HBsAg quantification were noticed according to HBV genotype or HBsAg variant.
authors.affiliation: AP-HP, Pitié-Salpêtrière Hospital, Virology Department, Paris, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Pancher
authors.affiliation: AP-HP, Pitié-Salpêtrière Hospital, Virology Department, Paris, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Désiré
authors.affiliation: AP-HP, Pitié-Salpêtrière Hospital, Service d'Hépato-Gastro-Entérologie, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR 8149, F-75005 Paris, France.
authors.forename: Yen
authors.initials: Y
authors.lastname: Ngo
authors.affiliation: AP-HP, Pitié-Salpêtrière Hospital, Virology Department, Paris, France.
authors.forename: Sepideh
authors.initials: S
authors.lastname: Akhavan
authors.affiliation: AP-HP, Paul Brousse Hospital, Virology, Villejuif, France.
authors.forename: Coralie
authors.initials: C
authors.lastname: Pallier
authors.affiliation: AP-HP, Pitié-Salpêtrière Hospital, Service d'Hépato-Gastro-Entérologie, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR 8149, F-75005 Paris, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Poynard
authors.affiliation: AP-HP, Pitié-Salpêtrière Hospital, Virology Department, Paris, France; Inserm U1135, F-75013 Paris, France. Electronic address: vincent.thibault@psl.aphp.fr.
authors.forename: Vincent
authors.initials: V
authors.lastname: Thibault
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016477:Artifacts; D002353:Carrier State; D005260:Female; D005838:Genotype; D006510:Hepatitis B Antibodies / Q000097:blood / Q000276:immunology*; D006514:Hepatitis B Surface Antigens / Q000097:blood / Q000235:genetics / Q000276:immunology*; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology*; D019694:Hepatitis B, Chronic / Q000097:blood* / Q000175:diagnosis / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011933:Reagent Kits, Diagnostic / Q000592:standards; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D011933:Reagent Kits, Diagnostic
keywords: Genotype; HBsAg quantification; HBsAg variant; Immune complexes; Interference