Serum hepatitis B core‐related antigen level stratifies risk of disease progression in chronic hepatitis B patients with intermediate viral load

Summary Background Patients with chronic hepatitis B virus (HBV) infection are at risk of developing liver disease. Serum hepatitis B core‐related antigen (HBcrAg) is a new biomarker for intrahepatic templates for HBV replication. Aim To explore whether a high HBcrAg level is associated with increas...

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Published in:Alimentary pharmacology & therapeutics Vol. 53; no. 8; pp. 908 - 918
Main Authors: Tseng, Tai‐Chung, Liu, Chun‐Jen, Yang, Wan‐Ting, Hsu, Chen‐Yang, Hong, Chun‐Ming, Su, Tung‐Hung, Tsai, Cheng‐Hsueh, Chen, Chi‐Ling, Yang, Hung‐Chih, Liu, Chen‐Hua, Chen, Hsiu‐Hsi, Chen, Pei‐Jer, Kao, Jia‐Horng
Format: Journal Article
Language:English
Published: England Wiley Subscription Services, Inc 01.04.2021
Subjects:
Alanine
Alanine transaminase
Antigens
Chronic infection
Cirrhosis
Deoxyribonucleic acid
Disease Progression
DNA
DNA, Viral
Hepatitis B
Hepatitis B Core Antigens
Hepatitis B e antigen
Hepatitis B e Antigens
Hepatitis B virus - genetics
Hepatitis B, Chronic - complications
Humans
Interferon
Liver cirrhosis
Liver diseases
Risk assessment
Symptom Flare Up
Viral Load
ISSN:0269-2813, 1365-2036, 1365-2036
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Summary:Summary Background Patients with chronic hepatitis B virus (HBV) infection are at risk of developing liver disease. Serum hepatitis B core‐related antigen (HBcrAg) is a new biomarker for intrahepatic templates for HBV replication. Aim To explore whether a high HBcrAg level is associated with increased risk of cirrhosis, especially in patients with intermediate viral load (HBV DNA 2000‐19 999 IU/mL) due to their moderate risk of disease progression. Methods A total of 1673 treatment‐naïve, non‐cirrhotic patients with negative hepatitis B e antigen (HBeAg) and alanine aminotransferase (ALT) level <40 U/L at baseline were enrolled. We explored the relationship between baseline levels of HBcrAg and cirrhosis development in all patients, and whether a higher HBcrAg level (<10 vs ≥10 KU/mL) was associated with an increased risk of disease progression in those with intermediate viral load. Results Of the 1673 patients, 104 developed cirrhosis after a mean follow‐up of 15.9 years. Higher HBcrAg levels were associated with increased incidence of cirrhosis, cirrhosis‐related complications, and liver‐related death. In 445 patients with intermediate viral load, the cirrhosis risk stratified by HBcrAg level of 10 KU/mL yielded a hazard ratio of 3.22 (95% CI: 1.61‐6.47). The risk stratification remained significant when exploring other pre‐cirrhosis endpoints, including HBeAg‐negative hepatitis, hepatitis flare, and HBV DNA >20 000 IU/mL after 3 years of follow‐up. Conclusions In HBeAg‐negative patients with normal ALT levels, higher HBcrAg levels are associated with increased risk of cirrhosis. Among those with intermediate viral load, HBcrAg <10 KU/mL defines a low‐risk group for disease progression.
Bibliography:The Handling Editor for this article was Professor Geoffrey Dusheiko, and it was accepted for publication after full peer‐review.
Funding information
This work was supported by the grants from the National Taiwan University Hospital (107‐N4041, 108‐N4157, 109‐N4644, 109‐P05), the Ministry of Science and Technology, Executive Yuan, Taiwan (MOST 106‐2314‐B‐002 −136) and the National Health Research Institutes (NHRI‐EX108‐10807BC).
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ISSN:0269-2813
1365-2036
1365-2036
DOI:10.1111/apt.16266