Clinical and Histopathological Correlation of Quantitative HBsAg Levels in Chronic Hepatitis B.

Objective

This study is aimed at comparing different clinical forms of chronic hepatitis B (CHB) infection (HBeAg-negative chronic HBV infection and HBeAg-positive and HBeAg-negative CHB patients) and evaluate their demographic, laboratory, virological, and histopathological characteristics, as well as investigate the relationship between quantitative HBsAg (qHBsAg) levels and these parameters. Materials and

Methods

This prospective study included a total of 307 patients, comprising 142 HBeAg-negative chronic HBV infection and 165 CHB patients (39 HBeAg-positive and 126 HBeAg-negative). Patient data, including age, sex, ALT, AST, GGT, ALP, total bilirubin, HBV DNA, and qHBsAg levels, were recorded. Additionally, liver biopsy was performed in 111 cases (31 HBeAg-positive and 80 HBeAg-negative), and histological activity index (HAI) and fibrosis staging (ISHAK score) were evaluated.

Results

No significant differences were observed between HBeAg-negative chronic HBV infection and CHB patients in age and sex distribution. In the CHB group, ALT and HBV DNA levels were significantly higher (p = 0.014 and p = 0.025, respectively). Among CHB patients, HBeAg-positive patients had significantly lower qHBsAg levels than HBeAg-negative patients (1805 vs. 4028 IU/mL, p < 0.001). Histopathological evaluations showed no significant association between qHBsAg levels and fibrosis severity (ISHAK score > 2) or necroinflammatory activity (HAI > 6). ROC analysis confirmed the limited diagnostic value of qHBsAg for advanced fibrosis (AUC 0.511, 95% CI 0.454-0.569). In HBeAg-positive patients, a weak negative correlation was found between qHBsAg and HBV DNA levels (r = -0.388, p = 0.015). Discussion: Our study demonstrated variability in laboratory findings across different forms of CHB. Notably, HBeAg-positive patients exhibited high HBV DNA levels alongside low qHBsAg levels. The limited efficacy of qHBsAg as a fibrosis marker suggests caution in its clinical use. These findings underscore the importance of considering multiple parameters in assessing liver damage.