title: Low serum hyaluronic acid levels associated with spontaneous HBsAg clearance.
abstract: OBJECTIVE
  The pathophysiological underlying mechanism of spontaneous HBsAg clearance in hepatitis B virus (HBV) infected patients is largely unknown. However, serum hyaluronic acid (sHA) plays a role in liver fibrosis progression and reversely could serve as a potential biomarker for HBsAg clearance. This study investigates whether low sHA is associated with HBsAg loss in non-Asian HBV patients.
  
  
  METHODS
  Non-Asian women living in Amsterdam with known chronic HBV infection between 1990-2003 were invited for a single follow-up visit at the Municipal Health Service Amsterdam between September 2011 to May 2012. Serum hyaluronic acid and liver stiffness measurement together with clinical evaluation, biochemical and virologic blood tests were performed.
  
  
  RESULTS
  Of the 160 women, HBsAg loss occurred in 38 (23 %) patients between diagnosis and follow-up. sHA levels were lower in HBsAg negative patients compared to HBsAg positive patients (14.5 [9.4-27.2] ng/mL vs 25.0 [12.3-42.5] ng/mL, p <0.01). A similar distinction in sHA between low and high HBV DNA was noted. sHA had a significant discriminatory ability to differentiate between HBsAg positive and HBsAg negative patients, (AUC 0.65 [95 % CI 0.55-0.75], p < 0.01). In multivariable analysis only sHA level was associated with HBsAg loss (OR 0.4 [0.2-0.9]). Finally, F3-F4 fibrosis (cut-off >8.1 kPa) was diagnosed in 3 % in HBsAg negative patients compared to 10 % in HBsAg positive patients (p = 0.15).
  
  
  CONCLUSIONS
  Serum HA levels are lower in patients who experience spontaneous HBsAg loss compared to HBsAg positive patients.
authors: Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Heidelberglaan 100, P.O. Box 85500, F02.126, 3508, GA, Utrecht, The Netherlands. s.harkisoen@umcutrecht.nl.
authors: S
authors: S
authors: Harkisoen
authors: Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Heidelberglaan 100, P.O. Box 85500, F02.126, 3508, GA, Utrecht, The Netherlands.
authors: J E
authors: JE
authors: Arends
authors: 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 Center, Amsterdam, The Netherlands.
authors: A
authors: A
authors: van den Hoek
authors: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: K J
authors: KJ
authors: van Erpecum
authors: Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: G J
authors: GJ
authors: Boland
authors: Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Heidelberglaan 100, P.O. Box 85500, F02.126, 3508, GA, Utrecht, The Netherlands.
authors: A I M
authors: AI
authors: Hoepelman
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D005260:Female; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D019694:Hepatitis B, Chronic / Q000473:pathology*; D006801:Humans; D006820:Hyaluronic Acid / Q000097:blood*; D008875:Middle Aged; D009426:Netherlands; D012075:Remission, Spontaneous; D044967:Serum / Q000737:chemistry*
chemical_list: D015415:Biomarkers; D006514:Hepatitis B Surface Antigens; D006820:Hyaluronic Acid