Evolution of viral biomarkers in predicting outcomes of chronic hepatitis B patients: From DNA to surface antigen
Journal
Tzu Chi Medical Journal
Journal Volume
25
Journal Issue
2
Pages
75-81
Date Issued
2013
Author(s)
Abstract
Quantification of hepatitis B virus (HBV) DNA and quantitative hepatitis B surface antigen (HBsAg) have improved our understanding and management of chronic hepatitis B (CHB). Both HBV DNA and HBsAg levels are highest in the immune tolerance phase, start to decline during the immune clearance phase, and further decline after hepatitis B e antigen (HBeAg) seroconversion. These levels are lowest in the inactive carrier state but rise again in patients who develop HBeAg-negative hepatitis. Previous studies have shown that an HBV DNA level ?2000IU/mL is associated with high risks of hepatocellular carcinoma, liver cirrhosis, and hepatitis activity, whereas a lower HBV DNA level is associated with a better chance of HBsAg loss, which is very close to a clinical cure for HBV infection. Recent studies further suggested that HBsAg level is not only a better predictor of HBsAg loss compared with the HBV DNA level, but also can complement the HBV DNA level in predicting HBV-related adverse events in patients with an HBV DNA level <2000IU/mL. In the Asia Pacific region, where HBV genotypes B and C prevail, an HBsAg level ?100IU/mL has been shown to serve as a predictor of HBsAg loss over time. In HBeAg-negative patients with an HBV DNA level <2000IU/mL, an HBsAg level >1000IU/mL is associated with higher risks of hepatocellular carcinoma, cirrhosis, and HBeAg-negative hepatitis. European studies also indicated that combining levels of HBsAg <1000IU/mL and HBV-DNA <2000IU/mL aids in identifying true inactive carriers in genotype D HBeAg-negative carriers. All this evidence highlights the evolution of viral biomarkers in predicting the prognosis of CHB. Quantitative HBsAg can complement HBV DNA in optimizing the management of CHB patients in clinical practice. ? 2013, Buddhist Compassion Relief Tzu Chi Foundation.
Subjects
HBsAg; HBV; HCC; Hepatitis; QHBsAg
SDGs
Other Subjects
alanine aminotransferase; hepatitis B surface antigen; hepatitis B(e) antigen; virus DNA; adverse outcome; alanine aminotransferase blood level; cancer risk; clinical practice; disease activity; disease duration; envelope gene; extracellular matrix; follow up; genotype; hepatitis B; Hepatitis B virus; human; immunological tolerance; life cycle; liver cell carcinoma; liver cirrhosis; Pacific islands; prognosis; review; seroconversion; viral clearance; virus detection; virus load; virus reactivation; virus replication
Type
review