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Progressive and sufficient decrease of hepatitis B core antibody can predict the disappearance of hepatitis B virus
M Kobyashi1, K Chayama, Y Arase
1Liver Research Laboratory, Toranomon Hospital, Tokyo, Japan.
Insights
Hepatitis B virus (HBV) DNA is rarely detectable years after hepatitis B surface antigen (HBsAg) clearance, especially with low hepatitis B core antibody (HBcAb) titers. This suggests HBV clearance is often complete, even if viral DNA is undetectable.
Area of Science:
- Hepatology
- Virology
- Immunology
Background:
- Hepatitis B virus (HBV) infection is a global health concern.
- Understanding viral kinetics after hepatitis B surface antigen (HBsAg) clearance is crucial for managing chronic infection.
- The role of hepatitis B core antibody (HBcAb) titer in predicting viral clearance requires further investigation.
Purpose of the Study:
- To investigate the relationship between serum HBV DNA levels, time since HBsAg clearance, and HBcAb titer.
- To assess the detectability of HBV DNA in patients with and without prior treatment.
- To determine the long-term viral kinetics following HBsAg seroconversion.
Main Methods:
- Longitudinal study of 12 patients with HBsAg clearance.
- Categorization into untreated (Group A) and prednisolone withdrawal therapy (Group B) groups.
- Serum HBV DNA quantification using nested polymerase chain reaction (PCR).
- Monitoring of HBsAg and HBcAb titers over extended follow-up periods (median 86-108 months).
Main Results:
- Serum HBV DNA became gradually undetectable after HBsAg clearance in both groups.
- The rate of detectable HBV DNA was significantly lower at ≥5 years post-HBsAg clearance compared to <5 years (P=0.004 for Group A, P=0.010 for Group B).
- HBV DNA detection was challenging in sera with HBcAb titers ≤30% and >5 years post-HBsAg clearance.
Conclusions:
- HBV DNA is rarely detectable in serum long after HBsAg clearance, particularly with low HBcAb titers.
- The study suggests a high likelihood of complete viral clearance in many patients post-HBsAg seroconversion.
- Even with negative HBsAg and HBcAb, HBV DNA is seldom found in serum, indicating a very low level of persistent viraemia.
Abstract:
The aim of this study was to elucidate the relationships among serum levels of hepatitis B virus (HBV) DNA, periods after hepatitis B surface (HBs) antigen clearance, and the titer of hepatitis B core (HBc) antibody in 200-fold diluted serum. Twelve patients who had clearance of HBs antigen from serum were studied. Five patients had not received any treatment (group A), and seven had received prednisolone withdrawal therapy. The patients in groups A and B were followed up for 86 months and 108 months (median), respectively. Serum HBV was measured by the nested polymerase chain reaction method. In both groups, serum HBV tended to become gradually undetectable after HBs antigen clearance. The positive rate of HBV in the sera 5 years or more after HBs antigen clearance was significantly lower than that in the sera at less than 5 years, both in group A (P = 0.004) and group B (P = 0.010). In both groups, the titer of HBs tended to decline every year after HBs antigen clearance. HBV was still detectable in the sera of some patients for a long period of time after they showed seroconversion to HBs antibody. The results suggest that detection of HBV was difficult in sera with an HBc titer of 30% or lower and at more than 5 years after HBs antigen clearance in both groups. It is important to note that HBV DNA rarely exists in the serum, even when HBs antigen and HBc are both negative.