Large spontaneous HBV DNA fluctuations and potential usefulness of a single-point measurement of combined HBV DNA and quantitative HBsAg for the exclusion of HBeAg-negative chronic hepatitis B: A prospective Tunisian cohort study

IF 1.1 4区 医学 Q4 GASTROENTEROLOGY & HEPATOLOGY
Amel Chtourou , Saba Gargouri , Emna Elleuch , Lamia Feki , Fahmi Smaoui , Awatef Taktak , Khouloud Mnif , Mondher Kassis , Adnene Hammami , Mounir Ben Jemaa , Hela Karray
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Abstract

Background and study aim

During the natural course of HBeAg-negative chronic hepatitis B (CHB), fluctuations in hepatitis B virus (HBV) DNA and alanine aminotransferase (ALT) levels are often observed, making the classification of patients difficult. We aimed to describe spontaneous short-term HBV DNA level fluctuations and to assess the usefulness of qHBsAg in Tunisian patients with HBeAg-negative chronic HBV infection.

Patients and methods

We included 174 treatment-naive Tunisian patients with HBeAg-negative chronic HBeAg-negative HBV infection. A prospective 1-year follow-up was conducted with serial determinations of HBV DNA, ALT levels, and qHBsAg. The patients were classified into three groups: inactive carriers (G1), patients with negative HBeAg CHB (G2), and patients with an “indeterminate state” (G3). For the latter group, a liver biopsy was indicated.

Results

Only genotype D was detected. During follow-up, 21.6% and 19.5% of patients with a low initial (<2,000 IU/ml) and intermediate viral load (2,000–20,000 IU/ml) experienced a subsequent increase in their HBV DNA levels above 2,000 and 20,000 IU/ml, respectively. Significant variations in viral load were observed in 61.1% of patients at 6-month intervals. Among the 174 patients, 89 (51.1%) belonged to G1, 33 (19%) to G2, and 52 (29.9%) to G3. Fourteen patients have undergone a liver biopsy, of whom seven showed moderate to severe liver disease. Combination of HBV DNA < 2,000 IU/ml and qHBsAg < 832 IU/ml excluded CHB in 98.4% of cases. A cutoff point for qHBsAg < 100 IU/ml associated with an annual decline of > 0.5 log 10 IU/ml is a good predictor marker of functional cure for hepatitis B.

Conclusions

This study highlights the large short-term fluctuations in HBV DNA in patients with HBeAg-negative chronic HBeAg-negative HBV infection with genotype D. Thus, using the cutoff value of 832 for qHBsAg combined with that of 2,000 for HBV DNA makes it possible to exclude CHB for most patients.

大自发性HBV DNA波动和HBV DNA联合单点测量和定量HBsAg对排除hbeag阴性慢性乙型肝炎的潜在有用性:一项前瞻性突尼斯队列研究。
背景与研究目的:在hbeag阴性慢性乙型肝炎(CHB)的自然病程中,经常观察到乙型肝炎病毒(HBV) DNA和丙氨酸转氨酶(ALT)水平的波动,给患者的分类带来困难。我们的目的是描述自发的短期HBV DNA水平波动,并评估qHBsAg在突尼斯hbeag阴性慢性HBV感染患者中的有效性。患者和方法:我们纳入了174例未接受治疗的突尼斯hbeag阴性慢性hbeag阴性HBV感染患者。前瞻性随访1年,检测HBV DNA、ALT水平和qHBsAg。将患者分为无活性携带者(G1)、HBeAg阴性CHB患者(G2)和“不确定状态”患者(G3)三组。后一组则行肝活检。结果:仅检测到基因型D。在随访中,21.6%和19.5%的患者初始低(0.5 log 10 IU/ml)是乙型肝炎功能治愈的良好预测指标。结论:本研究强调hbeag阴性的慢性hbeag阴性HBV感染基因型d患者的HBV DNA短期波动较大,因此,使用qHBsAg的832截断值结合HBV DNA的2000截断值可以排除大多数患者的CHB。
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来源期刊
Arab Journal of Gastroenterology
Arab Journal of Gastroenterology Medicine-Gastroenterology
CiteScore
2.70
自引率
0.00%
发文量
52
期刊介绍: Arab Journal of Gastroenterology (AJG) publishes different studies related to the digestive system. It aims to be the foremost scientific peer reviewed journal encompassing diverse studies related to the digestive system and its disorders, and serving the Pan-Arab and wider community working on gastrointestinal disorders.
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