On-treatment monitoring of liver fibrosis with serum hepatitis B core-related antigen in chronic hepatitis B.

Abstract

BACKGROUND:

Non-invasive evaluation for liver fibrosis is clinically important, especially in patients with undetectable hepatitis B virus (HBV) DNA treated with nucleoside analogs.

AIM:

To clarify the monitoring power of hepatitis B core-related antigen (HBcrAg) for hepatic histologic changes in patients with chronic hepatitis B (CHB) treated with entecavir.

METHODS:

This prospective multicenter study used multiple ordinal and multivariate logistics regression analysis to assess variables associated with Ishak fibrosis score and regression for fibrosis regression, respectively, in 403 CHB patients, including 374 with entecavir for 72 weeks (291 underwent paired liver biopsy) and 29 as controls.

RESULTS:

Level of HBcrAg correlated negatively with liver fibrosis staging (γ = -0.357, P < 0.001) in hepatitis B e antigen (HBeAg)-positive patients, and positively with liver fibrosis staging in HBeAg-negative patients. Higher HBcrAg concentration was associated with younger age, HBeAg positive status, high HBV DNA loads, high level of hepatitis B surface antigen (HBsAg) and higher necroinflammation, but not with HBV genotype. Serum concentration of HBcrAg, basal core promoter/precore (BCP/PC) mutant, quantitation of HBsAg (qHBsAg) and platelet counts were independently associated with Ishak fibrosis score on multiple ordinal regression. HBV DNA was undetectable in 88.37% of patients treated with entecavir at week 72, while their level of HBcrAg was still detectable. A greater reduction in post-treatment HBcrAg concentration was associated with the regression of hepatic fibrosis and histological improvement. HBcrAg concentration > 6.33 log IU/mL at baseline and logarithmic reduction > 1.03 log IU/mL at week 72 were associated with a higher chance of regression of liver fibrosis and histological improvement, respectively.

CONCLUSION:

HBcrAg level is associated with liver fibrosis progression. HBcrAg is an excellent monitor of hepatic histological changes, especially in CHB patients treated with nucleoside analogs.

• Authors: Xiu-Juan Chang, Chao Sun, Yan Chen, Xiao-Dong Li, Zu-Jiang Yu, Zheng Dong, Wen-Lin Bai, Xiao-Dong Wang, Zhi-Qin Li, Da Chen, Wen-Juan Du, Hao Liao, Qi-Yu Jiang, Li-Jun Sun, Yin-Yin Li, Cui-Hong Zhang, Dong-Ping Xu, Yong-Ping Chen, Qin Li, Yong-Ping Yang
• Journal: World journal of gastroenterology (World J Gastroenterol) Vol. 25 Issue 32 Pg. 4764-4778 (Aug 28 2019) ISSN: 2219-2840 [Electronic] United States
• PMID: 31528100 (Publication Type: Clinical Trial, Phase IV, Journal Article, Multicenter Study, Randomized Controlled Trial)

Chemical References

• Antiviral Agents
• Biomarkers
• DNA, Viral
• Hepatitis B Core Antigens
• entecavir
• Guanine

Topics

• Adult
• Antiviral Agents (therapeutic use)
• Biomarkers (blood)
• DNA, Viral (blood, isolation & purification)
• Disease Progression
• Female
• Guanine (analogs & derivatives, therapeutic use)
• Hepatitis B Core Antigens (blood, immunology, isolation & purification)
• Hepatitis B virus (immunology, isolation & purification)
• Hepatitis B, Chronic (blood, drug therapy, pathology)
• Humans
• Liver (pathology, virology)
• Liver Cirrhosis (blood, diagnosis, pathology)
• Male
• Middle Aged
• Prospective Studies
• Treatment Outcome