Buechter Matthias, Günther Arne Maria, Manka Paul, Gerken Guido, Kahraman Alisan
Department of Gastroenterology and Hepatology, University Clinic of Essen, University of Duisburg-Essen, 45147 Essen, Germany.
Department of Gastroenterology and Hepatology, Elisabeth Hospital, 58638 Iserlohn, Germany.
J Pers Med. 2024 Apr 5;14(4):390. doi: 10.3390/jpm14040390.
Chronic hepatitis B virus (HBV) infection is a global public health challenge since more than 250 million individuals are affected worldwide. Since different treatment modalities are available and not all patients are candidates for antiviral treatment, biomarkers that potentially predict the possibility of HBsAg clearance and seroconversion may be useful in clinical practice.
In this retrospective study, we aimed to identify factors positively correlated with HBsAg seroconversion in a large cohort of 371 chronic hepatitis B patients treated at a German tertial center between 2005 and 2020.
Seroconversion occurred in 25/371 (6.7%) and HBsAg loss in 29/371 patients (7.8%) with chronic HBV infection. Antiviral therapy was associated with a lower chance of seroconversion (seroconversion antiviral therapy 14/260 (5.4%) vs. therapy-naïve patients 11/111 (9.9%), = 0.027). Seroconversion rates were higher in patients with (very) low titers of HBV DNA (best cut-off value 357 IU/mL) and quantitative HBsAg. The best cut-off value with regard to seroconversion was 357 IU/mL for HBV DNA (AUC 0.693 (95%-CI 0.063-0.422), sensitivity 0.714, specificity 0.729; < 0.0005) and 33,55 IU/mL for HBsAg (AUC 0.794 (95%-CI 0.651-0.937), sensitivity 0.714, specificity 0.949; < 0.0005). However, male gender was positively associated with seroconversion (seroconversion: males 7.6% vs. females 2.7%, = 0.036).
Treatment-naïve male chronic HBV patients with low viral load and inflammatory activity have the best chance to achieve seroconversion. In the absence of cirrhosis, antiviral therapy should therefore not be performed in this patient collective.
慢性乙型肝炎病毒(HBV)感染是一项全球性的公共卫生挑战,全球有超过2.5亿人受到影响。由于存在不同的治疗方式,且并非所有患者都适合接受抗病毒治疗,因此,可能预测HBsAg清除和血清学转换可能性的生物标志物在临床实践中可能会有所帮助。
在这项回顾性研究中,我们旨在确定在2005年至2020年期间于德国一家三级中心接受治疗的371例慢性乙型肝炎患者的大型队列中,与HBsAg血清学转换呈正相关的因素。
在371例慢性HBV感染患者中,25例(6.7%)发生了血清学转换,29例(7.8%)出现了HBsAg消失。抗病毒治疗与血清学转换的几率较低相关(抗病毒治疗组血清学转换率为14/260(5.4%),未接受治疗的患者为11/111(9.9%),P = 0.027)。HBV DNA(最佳截断值为357 IU/mL)和定量HBsAg水平(非常)低的患者血清学转换率更高。就血清学转换而言,HBV DNA的最佳截断值为357 IU/mL(AUC为0.693(95%置信区间为0.063 - 0.422),灵敏度为0.714,特异性为0.729;P < 0.0005),HBsAg的最佳截断值为33.55 IU/mL(AUC为0.794(95%置信区间为0.651 - 0.937),灵敏度为0.714,特异性为0.949;P < 0.0005)。然而,男性性别与血清学转换呈正相关(血清学转换:男性为7.6%,女性为2.7%,P = 0.036)。
病毒载量和炎症活动度低的未接受过治疗的男性慢性HBV患者实现血清学转换的机会最大。因此,在不存在肝硬化的情况下,不应在这类患者群体中进行抗病毒治疗。