The Value Of Serum Anti-HBc Quantification In The Natural Course And Treatment Monitoring Of Patients With Chronic HBV Infection

ObjectiveTo investigate the distribution of serum quantitative hepatitis B virus core antibody(anti-HBc)levels in different natural history states of chronic hepatitis B virus(HBV)infection,the clinical value of distinguishing between different natural history states,the relationship between pre-and post-treatment and the degree of liver inflammation,and also to analyse the distribution of levels in different time periods of antiviral treatment with nucleos(t)ide analogues(NAs)in patients with CHB.MethodsOne hundred and eighty-six patients(August 2020-March 2022)with chronic HBV infection in the outpatient clinic of the Department of Infectious Diseases,The First Affiliated Hospital of Anhui Medical University were included.Based on natural history status,they are divided into Immune Clearance(IC)(n=45),Immune Tolerance(IT)(n=60),Reactive(ENH)(n=21)and Immune Control(LR)(n=60).Also included were330 patients with CHB treated with oral nucleoside(acid)analogues(NAs)antiviral therapy for 1-5 years during the same period.The value of quantitative anti-HBc levels for differentiating different natural history states was assessed by collecting general clinical data from patients;the correlation between quantitative anti-HBc levels and clinical indicators such as serum HBs Ag,HBe Ag,HBV DNA load,ALT,AST and TBi L was analysed;and the significance of quantitative anti-HBc levels in the CHB population after antiviral treatment was explored.ResultsThe quantitative anti-HBc levels in the different natural history states of chronic HBV infection ranged from high to low: log10IU/m L in the reactive phase 4.730(4.485～ 4.940),log10IU/m L in the immune clearance phase 4.360(4.095～4.780),log10IU/m L in the immune control phase 3.890(3.295～4.225)and log10IU/m L in the immune tolerant group 3.340(2.423～4.383).In the HBe Ag-positive CHB group,also called the immune clearance group,quantitative anti-HBc levels was positively correlated with AST(r=0.267,P=0.08);in the HBe Ag-negative CHB group,also known as the reactivation group,quantitative anti-HBc levels was positively correlated with ALT(r=0.635,P=0.002),HBV DNA(r=0.533,P=0.013)and AST(r=0.671,P<0.001)were positively correlated.The AUC for quantitative anti-HBc levels to differentiate between diagnostic immune tolerance status(IT)and HBe Ag-positive CHB(IC)was 0.727,and the AUC to differentiate between immune control phase(LR)and HBe Ag-negative CHB(ENH)was 0.907.The median quantitative anti-HBc levels in HBe Ag(+)and HBe Ag(-)chronic HBV-infected patients without treatment were 4.170(3.070-4.660)and 4.070(3.565-4.485),respectively,and the median quantitative anti-HBc levels in HBe Ag(+)and HBe Ag(-)CHB patients with NAs treatment for 1-5 years were 3.320(2.765 to 3.95)and 3.300(2.85 to 3.72)in log10 IU/m L.The quantitative anti-HBc levels in HBe Ag(+)CHB patients treated with NAs for one year was 3.935(3.120-4.270)log10IU/m L,3.220(2.775-3.780)log10IU/m L for two to three years and3.130(2.530-3.605)log10IU/m L for four to five years;the quantitative anti-HBc levels in HBe Ag(-)CHB patients treated with NAs for one year was 3.640(3.310-3.980)log10IU/m L,3.360(2.968-3.753)log10IU/m L for two to three years and2.980(2.600-3.403)log10IU/m Lfor four to five years.ConclusionThis paper shows that quantitative serum anti-HBc levels are a novel marker of the body’s immune status following HBV infection and correlate with the degree of liver inflammatory activity in patients with CHB.Dynamic monitoring of quantitative anti-HBc levels can be used in clinical practice to differentiate the stage of chronic HBV infection in patients and to assess whether liver inflammation has resolved after antiviral treatment.