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Aims: To investigate quantitative hepatitis B surface antigen (HBsAg) titers in relation to disease progression and serum markers of iron metabolism in chronic hepatitis B (CHB) patients. Methods: A total of 99 treatment-naïve CHB patients [median (min/max) age: 39.0 (17–66) years, 61.6% were males] with HBsAg positivity for at least six months were included in this study. Data on patient demographics, quantitative HBsAg titers (IU/mL), liver enzymes, hepatitis B virus (HBV) DNA levels, fibrosis stage, necroinflammatory scores and serum iron parameters including serum Fe (μg/dL), total iron binding capacity (TIBC; μg/dL), transferrin saturation (%), and ferritin (ng/mL) were recorded and compared with respect to gender and age (median age <40 years vs. ≥40 years). Results: Serum Fe (78.2 ± 29.5 vs. 111.7 ± 36.8 μg/dL, p = 0.001), transferrin saturation [0.2 (0.1–0.5) vs. 0.3 (0.1–1.0) %, p < 0.001], and ferritin [27 (3.9–298) vs. 100 (31– 994) ng/mL, p < 0.001] levels were significantly lower in females than in males. Quantitative HBsAg titers were correlated with age negatively in males overall (r = –0.328, p < 0.001) and positively in females >40 years of age (r = 0.722, p < 0.001). In females, quantitative HBsAg titers were positively with fibrosis stage (r = 0.491, p = 0.002), necroinflammatory grade (r = 0.235, p = 0.049), and ferritin (r = 0.288, p = 0.011) regardless of the age. In males, HBsAg titers were Nimet Yilmaz1, Hakan Çam2 Affiliations: 1Faculty of Medicine, Department of Internal Medicine, Division of Gastroenterology, University of Sanko, Gaziantep, Turkey; 2Private Meydan Health Institutions, Private Uncali Meydan Hospital, Division of Gastroenterology, Antalya, Turkey. Corresponding Author: Nimet Yilmaz, Faculty of Medicine, Department of Internal Medicine, Division of Gastroenterology, University of Sanko, Gaziantep, Turkey; Email: drnimet23@ hotmail.com Received: 01 January 2020 Accepted: 04 March 2020 Published: 20 May 2020 RE ARCH ARTICLE PEER REVIEWED | OPEN A CE S positively correlated with fibrosis stage (r = 0.501, p = 0.003), necroinflammatory grade (r = 0.471, p = 0.007), and HBV DNA (r = 0.313, p = 0.012) as well as with aspartate aminotransferase (AST) (r = 0.284, p = 0.021) and alanine aminotransferase (ALT) (r = 0.265, p = 0.031) only in those >40 years of age. Conclusion: In conclusion, our findings revealed lower serum iron parameters and association of quantitative HBsAg with ferritin levels in females and significant association of quantitative HBsAg with hepatitis markers in females regardless of age and in males after 40 years of age. Our findings also emphasize the likelihood of the more direct role of HBV-related liver injury rather than HBV infection per se in disturbed iron metabolism among female CHB patients and stronger association of HBsAg titers with HBV DNA and liver enzymes in males after 40 years of age.

Quantitative HBsAg titers in relation to disease progression and serum markers of iron metabolism among chronic hepatitis B patients