Premium
Serum Levels of Hepatitis B Surface Antigen and DNA Can Predict Inactive Carriers With Low Risk of Disease Progression
Author(s) -
Liu Jessica,
Yang HwaiI,
Lee MeiHsuan,
Jen ChinLan,
BatrlaUtermann Richard,
Lu ShengNan,
Wang LiYu,
You SanLin,
Chen ChienJen
Publication year - 2016
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.28552
Subject(s) - medicine , hbsag , receiver operating characteristic , hepatitis b virus , hepatocellular carcinoma , hazard ratio , hepatitis b , cirrhosis , confidence interval , gastroenterology , proportional hazards model , cohort , hepatology , immunology , oncology , virus
Serum levels of hepatitis B virus (HBV) DNA (≤2000 IU/mL) and hepatitis B surface antigen (HBsAg) (<1000 IU/mL) have been shown to distinguish inactive carriers with high accuracy. The goal of this study was to validate the predictability of one‐time measurement of quantitative HBsAg and HBV DNA levels for inactive carrier status and chronic hepatitis B (CHB) progression in a community‐based cohort. This study included 1529 participants chronically infected with HBV genotype B or C from the REVEAL‐HBV cohort. They were ascertained as inactive or active CHB after 18 months of follow‐up. Validity of the one‐time measurement was assessed by sensitivity, specificity, and receiver operating characteristic curves, while associations with clinical outcomes were calculated with Cox proportional hazards regressions. The one‐time baseline measurement of HBsAg <1000 IU/mL and HBV DNA <2000 IU/mL distinguished inactive carriers from active CHB with a sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 71%, 85%, 83%, 74%, and 78%, respectively. Those identified as inactive carriers using the one‐time baseline measurement had multivariate adjusted hazard ratios of 0.36 (95% confidence interval [CI], 0.20‐0.63) and 0.36 (0.23‐0.56) for hepatocellular carcinoma and liver cirrhosis, respectively, and an adjusted rate ratio of 6.97 (95% CI, 5.21‐9.33) for HBsAg seroclearance. Areas under the receiver operating characteristic curve of predicting these outcomes using the one‐time definition were similar to those obtained when using long‐term follow‐up defined carrier status for prediction. Conclusion : This study confirms the predictability of a one‐time combined HBsAg and HBV DNA measurement for future inactive carriers. This single‐point strategy provides new and complementary information useful for management of patients with chronic hepatitis B infection. (H epatology 2016;64:381‐389)