Clinical Significance of Hepatitis B Surface Antigen Quantification in Chronic Hepatitis B

Jong Eun Yeon

doi:10.4166/kjg.2014.63.6.335

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Yeon: Clinical Significance of Hepatitis B Surface Antigen Quantification in Chronic Hepatitis B

Review Article

Korean J Gastroenterol 2014;63(6):335-340.

Published online: 4 October 2014

DOI: https://doi.org/10.4166/kjg.2014.63.6.335

Clinical Significance of Hepatitis B Surface Antigen Quantification in Chronic Hepatitis B

Jong Eun Yeon

Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea

Correspondence to: Jong Eun Yeon, Department of Internal Medicine, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul 152-703, Korea. Tel: +82-2-2626-1030, Fax: +82-2-2626-1038, E-mail: jeyyeon@hotmail.com

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Since the discovery of HBsAg in the early 1960s, presence of HBsAg in serum has only served to diagnose hepatitis B. Recent development in the quantitative measurement of serum HBsAg has enabled us to improve our understanding on the management of chronic hepatitis B. The surface antigen (sAg) level is at its highest in immune tolerance phase and decreases to the lowest level in immune control/inactive phase when HBeAg is cleared from the serum. Combination of serum sAg titer less than 1,000 IU/mL and serum HBV DNA less than 2,000 IU/mL can identify true inactive carrier from e antigen (eAg) negative hepatitis with diagnostic accuracy of 95%. During the natural course of chronic hepatitis B, changes or absolute level of sAg less than certain level can predict spontaneous seroclearance of HBsAg. Although the decline of sAg is very slow in interferon (IFN)/pegylated interferon (PEG-IFN) or oral nucleos(−t)ide treated patients, interferon based therapy results in a greater decrease of sAg level and sAg loss. Lack of any decline in sAg titer during PEG-IFN therapy could identify the group of patients who do not response to IFN/PEG-IFN therapy. With the aid of serum HBV DNA, quantitative measurement of serum HBsAg level can be used to optimize the management of chronic hepatitis B in our daily practice.

Keywords: Hepatitis B surface antigen, Hepatitis B virus, Interferons, Antiviral, Phase

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Fig. 1.

Hepatitis B surface antigen (HBsAg) production. ER, endoplasmic reticulum; cccDNA, covalently closed circular DNA.

Table 1.

HBsAg Levels in Different Phases of Chronic Hepatitis B

Variable	Immune tolerance	Immune clearance	Inactive carrier	Reactivation HBeAg negative hepatitis
HBeAg	＋	＋	−	−
Anti-HBe antibody	−	−	＋	＋
HBV DNA (log₁₀ IU/mL)	7.5–8.5	6.0–8.0	1.0–2.5	3.9–5.5
ALT	Normal	Elevated	Normal	Elevated
Histology	None/mild	Moderate	Mild to liver cirrhosis	Moderate
HBsAg (log₁₀ IU/mL)	4.5–5.0	3.0–4.4	1.5–3.1	2.5–4.0

Table 2.

Decline of Serum HBsAg Levels during Antiviral Treatment

HBeAg	PEG-IFN	Oral nucleos(−t)ide
Positive	PEG-IFN, wk 48, 0.94 log₁₀ IU/mL	ETV, 0.38 log₁₀ IU/mL
	PEG-IFN, wk 78, 0.90 log₁₀ IU/mL	TDF, wk 144, 0.63 log₁₀ IU/mL
		LdT, wk 48, 0.5 log₁₀ IU/mL
Negative	PEG-IFN, wk 48, 0.56, log₁₀ IU/mL	ETV, –0.01 log₁₀ IU/mL
	PEG-IFN, wk 48, 0.71, log₁₀ IU/mL	LMV, wk 48, 0.02 log₁₀ IU/mL
	PEG-IFN+LMV, wk 48, 0.67 log₁₀ IU/mL

PEG-IFN, pegylated interferon; ETV, entecavir; TDF, tenofovir; LdT, telbivudine; LMV, lamivudine.

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