Hepatitis B surface antigen serum level is associated with fibrosis severity in treatment-naïve, e antigen-positive patients

• Published in: Journal of hepatology Vol. 58; no. 6; pp. 1089 - 1095
• Main Authors: Martinot-Peignoux, Michelle, Carvalho-Filho, Roberto, Lapalus, Martine, Netto-Cardoso, Ana Carolina Ferreira, Lada, Olivier, Batrla, Richard, Krause, Friedemann, Asselah, Tarik, Marcellin, Patrick
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.06.2013
• Subjects: Adult; Cross-Sectional Studies; Diagnostics; Female; Gastroenterology and Hepatology; Genotype; HBeAg; HBV DNA; Hepatitis B e Antigens - blood; Hepatitis B Surface Antigens - blood; Hepatitis B virus - classification; Hepatitis B virus - genetics; Hepatitis B, Chronic - complications; Hepatitis B, Chronic - virology; Humans; Liver Cirrhosis - etiology; Male; Middle Aged; Natural history; ROC Curve; Serum biomarkers; Severity of Illness Index; Viral hepatitis; chronic hepatitis B; Diagnostics; hepatitis B surface antigen; hepatitis B virus; CI; HBeAg; ROC; alanine aminotransferase; HCC; HBsAg; ALT; Serum biomarkers; hepatitis B e antigen; Viral hepatitis; HBV DNA; confidence interval; CHB; receiver operating characteristic; HBV; hepatocellular carcinoma; Natural history
• ISSN: 0168-8278; 1600-0641
• DOI: 10.1016/j.jhep.2013.01.028

Background & Aims Little is currently known about the association between serum HBsAg or HBV DNA levels and the severity of liver disease in chronic hepatitis B (CHB) patients. Therefore, we investigated these relationships in a large cohort of unselected, well-characterized, treatment-naïve CHB patients. Methods CHB patients were assessed at the Hôpital Beaujon in Paris, France, between 2000 and 2008. Serum samples and liver biopsies were obtained on the same day. HBsAg, HBV DNA, and HBV genotype were investigated using commercial diagnostic assays and liver histology was scored using the METAVIR system. Results 406 patients were included in this cross-sectional study. Serum HBsAg and HBV DNA levels in hepatitis B e antigen-positive (HBeAg[+]) patients showed strong correlation (r = 0.44, p <0.0001), as did serum HBsAg levels and fibrosis severity (r = 0.43, p <0.0001). HBeAg(+) patients with moderate to severe fibrosis exhibited significantly lower serum HBsAg and HBV DNA levels compared with patients with no or mild fibrosis. Modeling analysis suggested a serum HBsAg cut-off of 3.85 log IU/ml would provide a theoretical sensitivity of 100% (95% CI: 0–100), theoretical specificity of 86% (95% CI: 50–100), and a negative predictive value of 100% (95% CI: 67–100) in HBeAg(+) patients infected with HBV genotype B or C. Conclusions We found an association between low serum HBsAg levels and moderate to severe fibrosis in HBeAg(+) CHB patients. Furthermore, we described a serum HBsAg cut-off for the prediction of fibrosis severity in CHB patients infected with HBV genotype B or C.