VolumeVol. 53 • Number No. 3 • July - September 2015 Back

Original Paper

​​​​​​​Hepatitis B Surface Antigen Serum Titer: Correlation with Hepatitis B Virus DNA and Alanine Aminotransferase Levels Among Hepatitis B e Antigen-Negative Chronic Hepatitis B Patients

Authors: Mark Lester S. Sy, Jade D. Jamias

DOI: 10.65564/pjim.13a5d2235e

Date of Publication: September 2015

Abstract

Background and Aims: The precise identification of true inactive hepatitis B carrier is difficult due to frequent fluctuations in Hepatitis B virus (HBV) DNA and serum transaminase levels, needing serial determinations for a period of at least one year. Hence we correlated the hepatitis B surface antigen (HBs Ag) titer of untreated Hepatitis B e Antigen (HBe Ag)-negative patients with their corresponding HBV DNA and alanine aminotransferase (ALT) levels, classified these patients as either inactive carrier or patients in the reactivation phase using the American Association for the Study of Liver Diseases (AASLD) guidelines and finally determined if there was a significant difference in HBs Ag titer between these groups.

Methods: A cross sectional retrospective study was done. All HBe Ag- negative Chronic hepatitis B (CHB) patients who had their HBs Ag titer, HBV DNA and ALT done at National Kidney and Transplant Institute (NKTI) were obtained and clinical information was abstracted from their case records. A total of 40 patients were included in the study.

Results: The mean HBs Ag titer among untreated HBe Ag negative CHB patients was 3037.04 IU/mL (SD +/- 8718.94 IU/mL). Using Spearman’s coefficient of correlation, HBs Ag was found to be directly correlated with HBV DNA (R = 0.821, p = 0 < 0.05) and serum ALT (R = 0.654, p = 0 < 0.05). Moreover, using Mann Whitney T Test, the mean difference in HBs Ag titer between inactive carrier group (mean 103.72 IU/mL, SD +/- 144.25) and reactivation phase group (mean 5690.99 IU/mL, SD +/- 11517.39) was significant (p value = 0 < 0.05).

Conclusion: HBs Ag titer was found to be directly correlated with HBV DNA and ALT. To our knowledge, this is the first local study done that supports the concept that HBs Ag titer can provide complementary information in differentiating patient as true inactive carrier from those in the reactivation phase.

Keywords: Inactive hepatitis B carrier; Hepatitis B virus; Hepatitis B Reactivation; ccc DNA; HBs Ag quantification  

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References

  1. Dienstag JL. Hepatitis B Virus Infection. N Engl J Med 2008;359:1486e500.
  2. Department of Health Statistics 2009. http:// chd1.doh. gov.ph /index.php/statistics.
  3. Lok A, McMahon B. AASLD Practice Guidelines: Chronic Hepatitis B Update 2009.
  4. Hadziyannis S, Papatheodoridis GV. Hepatitis B e Antigen-Negative Chronic Hepatitis: Natural History and Treatment. Semin Liver Dis 2006;26:130–141.
  5. Martinot-Peignoux M, Boyer N, Colombat M, et al. Serum Hepatitis B Virus HBV DNA Levels and Liver Histology in Inactive HBsAg Carriers. J Hep 2002;36:543–546.
  6. Perrillo R. Benefits and Risks of Interferon Therapy for Hepatitis B. Hepatology 2009;49:103–111.
  7. Feld JJ, Ayers M, El-Ashry D, et al. Hepatitis B Virus DNA Prediction Rules For Hepatitis B e Antigen Negative Chronic Hepatitis B. Hepatology 2007;46:1057–1070.
  8. Blumberg BS, Sutnick AI, London WT. Hepatitis and Leukemia: Their Relation To Australia Antigen. Bull NY Acad Med 1968;44:1566–1586.
  9. Chan HL, Wong VW, Tse AM, et al. Serum Hepatitis B Surface Antigen Quantification Can Reflect Hepatitis B Virus In The Liver and Predict Treatment Response. Clin Gastroenterol Hepatol 2007;5:1462–1468.
  10. Jaroszewicz J, Calle Serrano B, Wursthorn K, et al. Hepatitis B Surface Antigen (HBsAg) Levels in the Natural History of Hepatitis B virus (HBV)-Infection: A European Perspective. J Hepatol 2010;52:514e22.
  11. Brunetto MR, Moriconi F, Bonino F, et al. Hepatitis B Virus Surface Antigen Levels: a Guide To Sustained Response to Peginterferon Alfa-2a in HBeAg-negative Chronic Hepatitis B. Hepatology 2009; 49:1141–1150.
  12. Chan HL, Wong GL, Tse CH, et al. Viral Determinants of Hepatitis B Surface Antigen Seroclearance in Hepatitis B e Antigen-Negative Chronic Hepatitis B Patients. J Infect Dis 2011;204:408–414.
  13. Su TH, Hsu CS, Chen CL, et al. Serum Hepatitis B Surface Antigen Concentration Correlates with HBV DNA Level in Patients with Chronic Hepatitis B. Antivir Ther 2010;15:1133–1139.
  14. Brunetto MR, Oliveri F, Colombatto P, et al. Hepatitis B Surface Antigen Serum Levels Help to Distinguish Active from Inactive Hepatitis B Virus Genotype D Carriers. Gastroenterology 2010;139:483–490.
  15. Gaeta GB, Stornaiuolo G, Precone DF, et al. Epidemiological and Clinical Burden of Chronic Hepatitis B Virus/ Hepatitis C Virus Infection. A Multicenter Italian Study. J Hepatol 2003;39:1036–1041.
  16. Tseng TC, Liu CJ, Su TH, et al. Serum Hepatitis B Surface Antigen Levels Predict Surface Antigen Loss in Hepatitis B e Antigen Seroconverters. Gastroenterology, 2011.
  17. Sugiyama M, Tanaka Y, Kato T, et al. Influence of Hepatitis B Virus Genotypes on the Intra- and Extracellular Expression of Viral DNA and Antigens. Hepatology 2006;44:915e24.
  18. Lontok MA, Bocobo JC, Predicala R, et al. Clinicopathologic differences of Hepatitis B Genotypes Among Filipino Patients. Phil J of Gastroenterology 2006; 2:79-86.
  19. Batoctoy KS, Tseng TC, Kao JH, et al. HBV/A and HBV/C Genotype Predominance Among Patients with Chronic Hepatitis B Virus Infection in Cebu City, Philippines. Hepatol Int. 2011; Sept 774-81.