Serial monitoring of hepatitis B virus (HBV) DNA and serum alanine transaminase (ALT) for at least one year is recommended to define an inactive carrier state. Recent studies proposed HBsAg levels as a marker for monitoring HBV infected patients. The aim of our study is to evaluate spontaneous HBV DNA fluctuations among Tunisian HBV infected patients and to assess the role of HBsAg quantification in the determination of viral disease activity.
Seventy three untreated HBeAg negative asymptomatic HBV infected patients were followed up prospectively during a one year period (2014). Patients with persistently serum HBV DNA levels < 2000 IU/ml and persistently normal ALT for at least one year,were considered as inactive carrier of HBsAg. Patients with HBV DNA level fluctuation ≥2000 IU/ml and/or ALT elevation were classified as chronic hepatitis B (CHB) patients.Serum samples for HBV DNA and ALT quantification were obtained at three times with an interval of 6 months (M0, M6 and M12). Quantification of HBsAg was performed at baseline for all patients. Serum HBV DNA was measured by real-time PCR. Serum HBsAg was quantified by Elecsys HBsAg II kit test. The logarithmic transformation was used for quantitative data without normal distribution. Statistical analysis was based on SPSS version 20.
Fourty eight (65,7%) patients were inactive carrier of HBsAg and 25 (34.2%) were CHB patients. HBV DNA over 2000 IU/ml was observed in 24% (6/25), 36% (9/25) and 40% (10/25) of CHB patients at M0, M6 and M12, respectively. HBV DNA fluctuation median was 0,63 log10 IU/ml [0,28- 3,2 ]. HBsAg levels were significantly lower in inactive carrier than CHB patients ( 2,52 log10 IU/ml vs 3,39 log10 IU/ml , p< 0,0001). However, there was no significant difference between the two groups regarding baseline HBV DNA to HBsAg levels ratio (0,78 vs 0,82, p= 0,49).
This study highlights the frequency and magnitude of spontaneous HBV DNA fluctuations over a short period of time among Tunisian HBV infected patients. HBsAg quantification could be helpful to define the most adequate management strategy to inactive HBsAg carrier patients. Large scale studies are strongly required to assess the real diagnostic value of HBsAg quantification.
E. Emna, None
F. B. Lamia, None
L. Dorra, None
M. Chakib, None
H. Adnene, None
B. J. Mounir, None
K. H. Hela, None