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Hepatitis B Core-Related Antigen Is Useful for Predicting Phase and Prognosis of Hepatitis B e Antigen-Positive
Han Ah Lee1, Hyun Woong Lee2, Younhee Park3
1Departments of Internal Medicine, Ewha Womans University College of Medicine, Seoul 07985, Korea.
Insights
Hepatitis B core-related antigen (HBcrAg) levels help predict chronic hepatitis B (CHB) clinical phases and nucleos(t)ide analogue treatment outcomes. Higher HBcrAg levels indicate the immune-tolerant phase and predict hepatitis B e antigen seroconversion in HBeAg-positive patients.
Area of Science:
- Hepatology
- Virology
- Immunology
Background:
- The clinical significance of hepatitis B core-related antigen (HBcrAg) in chronic hepatitis B (CHB) remains incompletely understood.
- Accurate definition of CHB phases and prediction of treatment response are crucial for patient management.
Purpose of the Study:
- To investigate the association of HBcrAg levels with CHB clinical phases.
- To evaluate HBcrAg as a predictor of nucleos(t)ide analogue (NA)-induced hepatitis B e antigen (HBeAg) seroconversion.
Main Methods:
- Retrospective analysis of 387 CHB patients who underwent liver biopsy.
- Histological classification of CHB phases: immune-tolerant (IT), HBeAg-positive immune-active (PIA), HBeAg-negative immune-active, and inactive.
- Multivariate and Cox regression analyses to identify predictors of CHB phase and HBeAg seroconversion.
Main Results:
- Higher HBcrAg levels were significantly associated with the immune-tolerant phase compared to the immune-active phase.
- Higher HBcrAg levels, younger age, and lower ALT were independent predictors of the IT phase.
- In patients receiving NA therapy, higher HBcrAg levels were the sole independent predictor of HBeAg seroconversion.
Conclusions:
- HBcrAg levels are valuable biomarkers for defining CHB clinical phases.
- HBcrAg can predict the likelihood of achieving HBeAg seroconversion in HBeAg-positive CHB patients undergoing NA treatment.
Abstract:
The role of hepatitis B core-related antigen (HBcrAg) level in defining clinical phase and predicting prognosis of chronic hepatitis B (CHB) has not been fully studied. CHB patients who had undergone liver biopsy in Korea University Medical Center were included. Patients with liver cirrhosis were excluded. The associations of HBcrAg level with CHB phase, and nucleos(t)ide analogue (NA)-induced hepatitis B e antigen (HBeAg) seroconversion were analyzed. In total, 387 patients (median follow-up of 82.4 months) were included. The CHB phases of patients were defined histologically as immune-tolerant (IT, n = 32, 8.3%), HBeAg-positive and immune-active (PIA, n = 211, 54.5%), HBeAg-negative and immune-active (n = 125, 32.3%), and inactive (n = 19, 4.9%), respectively. In HBeAg-positive patients, the mean HBV DNA levels were comparable between the two groups (p = 0.990). However, the mean HBsAg (7.4 log IU/mL and 6.9 log IU/mL, p = 0.002) and HBcrAg levels (8.2 log U/mL vs. 7.6 log U/mL, p < 0.001) of IT patients were significantly higher than that of PIA patients. In multivariate analysis, younger age (odds ratio [OR] 0.949, p = 0.025), lower alanine aminotransferase (OR 0.988, p = 0.002) and higher HBcrAg level (OR = 2.745 p = 0.022) were independent predictors of the IT phase. Of the patients in the PIA phase, 194 received NA after liver biopsy, and 61 (31.4%) had achieved HBeAg seroconversion after antiviral therapy. In Cox regression analysis, the higher HBcrAg level was the only independent predictor of the NA-induced HBeAg seroconversion (hazard ratio 1.285, p = 0.028). The HBcrAg level is useful for predicting clinical phase of CHB and NA-induced HBeAg seroconversion in HBeAg-positive patients.
