Hepatitis B Surface Antigen Levels During The Natural History Of Chronic Hepatitis B:a Zhejiang Province Cross-sectional Study

Backgroud and Aims Hepatitis B surface antigen (HBsAg) is known as an early marker of infection with the hepatitis B virus (HBV), and qualitative HBsAg assays is used as a screening tool for several decades. Now the quantitative assessment of HBsAg attracted more and more attention. This study aimed to determine baseline HBsAg during the different phases of chronic hepatitis B (CHB) in Zhejiang Province。Methods623HBV-infected patients without antiviral therapy before were analyzed in a cross-sectional study. And Patients were classified into five phases including immune-tolerant (IT, n=108), immune-clearance (IC, n=161), HBeAg negative hepatitis (ENH, n=149), low-replicative (LR, n=135), and liver cirrhosis (LC, n=70). HBsAg was quantified (Abbott ARCHITECT-assay) and correlated with HBV-DNA, and serum ALT/AST in each phase of CHB was also performed.Results Median HBsAg titres were different between each phase of CHB (p<0.001): IT (4.85logio IU/ml), IC (4.36logio IU/ml), ENH (2.95logio IU/ml), LR (3.18logio IU/ml) and LC (2.69log10IU/ml). HBsAg titres were highest in the IT phase, and lowest in the LC phase. Serum HBsAg titers showed most strong correlated with HBV viral load in the IC phase (r=0.683,p<0.001). No correlation between the serum HBsAg level and ALT/AST was observed.Conclusions This study shows mean HBsAg baseline levels differ significantly during the five phases of CHB. These findings provide further implications for the natural history of HBV-infection, and baseline HBsAg quantification may be used as a good marker for predicting treatment effect of immune-modulator therapy or oral nucleos(t)ide analogue therapy.