title: Chronic hepatitis B in pregnant women: is hepatitis B surface antigen quantification useful for viral load prediction?
abstract: BACKGROUND
  New cases of hepatitis B virus (HBV) infection continue to occur worldwide. Most of these are due to mother-to-child transmission (MTCT), with maternal viraemia as the most important contributing factor. The hepatitis B surface antigen (HBsAg) level, which correlates positively with viral load, has been used for treatment monitoring in chronic hepatitis B. This study evaluated the usefulness of quantitative HBsAg for viral load prediction in HBsAg-positive pregnant women.
  
  
  METHODS
  A total of 943 pregnant women in Makassar, Indonesia, were screened for HBsAg. Sixty-four women were HBsAg-positive and investigated. HBsAg level and hepatitis B e antigen (HBeAg)/hepatitis B e antibody (anti-HBe) status were determined serologically. Viral load was measured by real-time PCR. HBV DNA was sequenced and analysed for identification of genotype and basal core promoter (BCP)/precore (PC) mutations.
  
  
  RESULTS
  Of 64 subjects, 12 (18.8%) were HBeAg-positive and 52 (81.3%) were HBeAg-negative. HBsAg and HBV DNA levels were significantly higher in the HBeAg-positive group (p<0.001). HBsAg and HBV DNA levels were positively correlated in the HBeAg-positive group (r = 0.659; p=0.02), but not in the HBeAg-negative group (r=0.194; p=0.168). Low HBsAg levels (<3.0 log10 IU/ml) corresponded with HBV DNA levels<6.0 log10 IU/ml (r=0.404; p=0.001), a recognized threshold for MTCT. Genotype C was more prevalent than genotype B, but not associated with HBsAg level, viral load, or HBeAg status. Two-thirds of HBeAg-negative subjects with high HBV DNA levels harboured BCP (A1762T/G1764A) and/or PC (G1896A) variants.
  
  
  CONCLUSIONS
  HBsAg levels provide a good viral load predictor in HBeAg-positive but not HBeAg-negative pregnant women. The HBeAg-negative group had a frequent occurrence of BCP/PC variants, which may have contributed to the lack of correlation observed. Samples with a low HBsAg level, which is associated with a low risk of MTCT, do not require HBV DNA measurement.
authors.affiliation: Faculty of Medicine, Hasanuddin University, Makassar, South Sulawesi, Indonesia.
authors.forename: Masita
authors.initials: M
authors.lastname: Fujiko
authors.affiliation: Faculty of Medicine, Hasanuddin University, Makassar, South Sulawesi, Indonesia.
authors.forename: Maisuri T
authors.initials: MT
authors.lastname: Chalid
authors.affiliation: Eijkman Institute for Molecular Biology, Jl. Diponegoro 69, Jakarta Pusat 10430, DKI Jakarta, Indonesia.
authors.lastname: Turyadi
authors.affiliation: Eijkman Institute for Molecular Biology, Jl. Diponegoro 69, Jakarta Pusat 10430, DKI Jakarta, Indonesia.
authors.forename: Susan I
authors.initials: SI
authors.lastname: Ie
authors.affiliation: Faculty of Medicine, Hasanuddin University, Makassar, South Sulawesi, Indonesia.
authors.lastname: Maghfira
authors.affiliation: Faculty of Medicine, Hasanuddin University, Makassar, South Sulawesi, Indonesia.
authors.lastname: Syafri
authors.affiliation: Faculty of Medicine, Hasanuddin University, Makassar, South Sulawesi, Indonesia.
authors.forename: Ridha
authors.initials: R
authors.lastname: Wahyuni
authors.affiliation: Eijkman Institute for Molecular Biology, Jl. Diponegoro 69, Jakarta Pusat 10430, DKI Jakarta, Indonesia.
authors.forename: Martono
authors.initials: M
authors.lastname: Roni
authors.affiliation: Faculty of Medicine, Hasanuddin University, Makassar, South Sulawesi, Indonesia.
authors.forename: Ilhamjaya
authors.initials: I
authors.lastname: Patellongi
authors.affiliation: Faculty of Medicine, Hasanuddin University, Makassar, South Sulawesi, Indonesia.
authors.forename: M Nasrum
authors.initials: MN
authors.lastname: Massi
authors.affiliation: Faculty of Medicine, Hasanuddin University, Makassar, South Sulawesi, Indonesia; Eijkman Institute for Molecular Biology, Jl. Diponegoro 69, Jakarta Pusat 10430, DKI Jakarta, Indonesia; Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia. Electronic address: davidhm@eijkman.go.id.
authors.forename: David H
authors.initials: DH
authors.lastname: Muljono
mesh_terms: D000328:Adult; D001483:Base Sequence; D004279:DNA, Viral / Q000235:genetics; D005260:Female; D005838:Genotype; D006510:Hepatitis B Antibodies / Q000276:immunology; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D006513:Hepatitis B e Antigens / Q000235:genetics; D006515:Hepatitis B virus / Q000235:genetics; D019694:Hepatitis B, Chronic / Q000097:blood / Q000453:epidemiology / Q000821:virology*; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D018445:Infectious Disease Transmission, Vertical; D009154:Mutation; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000821:virology*; D015995:Prevalence; D011401:Promoter Regions, Genetic; D060888:Real-Time Polymerase Chain Reaction; D012698:Serologic Tests; D019562:Viral Load; D014766:Viremia / Q000276:immunology; D055815:Young Adult
chemical_list: D004279:DNA, Viral; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D006513:Hepatitis B e Antigens
keywords: HBV DNA level; HBV vertical transmission; HBsAg level; Mother-to-child-transmission; Pregnant women