Serum
HBsAg and HBV
DNA levels in
HBeAg-positive CHB patients with liver biopsies were analyzed. The upper limit of normal (ULN) of
alanine aminotransferase (ALT) was 30 and 19 U/L for men and women respectively. Histologic assessment was based on Ishak
fibrosis staging for
fibrosis and Knodell histologic activity index (HAI) for necroinflammation.
RESULTS: 140 patients (65% male, median age 32.7 years) were recruited. 56 (40%) had ALT ≤2×ULN. 72 (51.4%) and 42 (30%) had
fibrosis score ≤ 1 and necroinflammation grading ≤ 4 respectively. Patients with
fibrosis score ≤ 1, when compared to patients with
fibrosis score >1, had significantly higher median
HBsAg levels (50,320 and 7,820 IU/mL respectively, p<0.001). Among patients with ALT ≤2×ULN, serum
HBsAg levels achieved an area under receiver operating characteristic curve of 0.869 in predicting
fibrosis score ≤ 1.
HBsAg levels did not accurately predict necroinflammation score.
HBsAg ≥ 25,000 IU/mL was independently associated with
fibrosis score ≤ 1 (p=0.025, odds ratio 9.042).Using this cut-off
HBsAg level in patients with ALT ≤2×ULN, positive and negative predictive values for predicting
fibrosis score ≤ 1 were 92.7% and 60.0% respectively. HBV
DNA levels had no association with liver histology.
CONCLUSION: Among
HBeAg-positive patients with ALT ≤2×ULN, high serum
HBsAg levels can accurately predict
fibrosis score ≤ 1, and could potentially influence decisions concerning treatment commencement and reduce the need for liver biopsy.