Hepatitis B surface antigen level complements viral load in predicting viral reactivation in spontaneous HBeAg seroconverters

Abstract

Background and Aims: The level of hepatitis B surface antigen (HBsAg) has been shown to complement hepatitis B virus (HBV)-DNA level in predicting disease progression in hepatitis B e antigen (HBeAg)-negative patients, especially those with low viral loads. Whether this finding could be seen in spontaneous HBeAg seroconverters remains unclear. Methods: A retrospective cohort of 390 Taiwanese spontaneous HBeAg seroconverters with a mean follow-up period of 7.4 years was enrolled. The relationships between HBV-DNA/HBsAg levels and HBeAg-negative hepatitis/active viral replication (HBV-DNA level ?2000IU/mL) were investigated. Results: In the overall cohort, serum HBV-DNA level served as a better predictor for HBeAg-negative hepatitis compared with HBsAg level. However, in those with HBV-DNA level <2000IU/mL, a higher HBsAg level was associated with a higher risk of HBeAg-negative hepatitis (P=0.015). Multivariate analysis showed the hazard ratio of HBsAg level ?1000IU/mL versus <1000IU/mL was 4.1 (95% confidence interval: 1.3-13.6). When using the end-point of active viral replication, HBsAg ?1000IU/mL remained as an independent risk factor, with a hazard ratio of 2.5 (95% confidence interval: 1.1-5.9). Conclusions: In spontaneous HBeAg seroconverters with HBV-DNA level <2000IU/mL, HBsAg level ?1000IU/mL is associated with increased risks of HBeAg-negative hepatitis and active viral replication. Combining HBV-DNA <2000IU/mL and HBsAg level <1000IU/mL may be used to define minimal viral activity. ? 2014 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.