Decreasing Levels of HBsAg Predict HBsAg Seroclearance

[stef2011]

http://www.ncbi.nlm.nih.gov/pubmed/21893131

Clin Gastroenterol Hepatol. 2011 Sep 2. [Epub ahead of print]
Decreasing Levels of HBsAg Predict HBsAg Seroclearance in Patients with Inactive Chronic Hepatitis B Virus Infection.
Chen YC, Jeng WJ, Chu CM, Liaw YF.
Source
Liver Research Unit, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan.
Abstract
BACKGROUND & AIMS:
Serum levels of hepatitis B surface antigen (HBsAg) decrease gradually during chronic hepatitis B virus (HBV) infection. We investigated the association between levels of HBsAg and HBsAg seroclearance.

METHODS:
We studied data from 46 patients who underwent spontaneous seroclearance of HBsAg (median age at seroclearance, 48 years; 87% male; 76% infected with genotype B). Controls were 46 patients matched for age, sex, and HBV genotype, with persistently normal levels of alanine aminotransferase and were seropositive for HBsAg. Levels of HBsAg were assessed in serum specimens collected 5 years, 3 years, and 1 year before HBsAg seroclearance (or at the last examination, for controls).

RESULTS:
The decrease in level of HBsAg was significant and accelerated within the 3 years before HBsAg seroclearance; there was no significant decrease in serum level of HBsAg among controls (P<.0001). The positive predictive value (PPV) for HBsAg seroclearance within 1 year was 36% among patients with HBsAg levels of 200 IU/mL, increasing to 44%, 54%, and 67% among those with 100 IU/mL, 50 IU/mL, or 10 IU/mL respectively; the negative predictive value (NPV) for these levels was ≥96%. The combination of HBsAg level <200 IU/mL and a decrease of ≥1 log10 IU/mL in a preceding 2-year period had PPVs of 97% and 100% for HBsAg seroclearance at 1 and 3 years, respectively; the NPVs were 100% and 92%, respectively.

CONCLUSIONS:
The decrease in the level of HBsAg accelerates during the 3 years before HBsAg seroclearance. Levels of HBsAg ≤200 IU/mL have high NPVs for HBsAg seroclearance; PPVs increase to 97%-100% when combined with a ≥1 log IU/mL decrease in level of HBsAg over a 2-year period.

[smile_boy]

Hi Stef,

Thanks for the reply. Currently im taking 1.5g Alinia per day with Vit D and selenium . I will consider taking Simvastnin 40mg -80mg daily after taking HBV DNA pcr test

I haven't taken the HBV DNA since last year. Planning to take complete test this month end

[stef2011]

you are one of the very likely, you started alinia with a level more than 1000iu/ml so 3log and decreased to about 500iu/ml 1log in a short time (you are now at 2 logs).....i am sure you will clear by the years and if hbsag keeps increasing again interferon will beat it down

consider that interferon makes 1-2 logs down on responders, and you suing alinia+sim+vit d can force to be in responder group very likly.....so with interferon you'd get to zero hbsag with very high chances

while if alinia makes your hbsag at about 300iu/ml by the end of the year we can also keep alinia mono and see what it does.

have you considered to try alinia+sim?

[smile_boy]

tthanks stef.ppl with hbsag less than 200iu/ml having more chances of natural seroconversion.

[enolia]

Thanks Steff. Too bad no lab in Canada does the HBsAg quantitative test...I hope one we can all do this test.