Dilemma of HBsAg seroconversion in chronic hepatitis B infection

Patients with chronic hepatitis B infection should be followed up to identify possible changes in disease status, such as HBsAg seronversion. There are little data on the outcome of such cases, and the response rate to HBV vaccine has not been discussed extensively

Hepatitis B virus DNA level as predictor of response to therapy with interferon-alpha-2b [Pdferon] in chronic hepatitis B infection

To evaluate the strength of association and to determine the best prediction of response in terms of sensitivity and specificity among quantitative baseline HBV-DNA levels in blood serum in patients with chronic hepatitis B [CHB] infection who treated with interferon-alpha-2b. Totally, 78 CHB patients with serum HBV-DNA>10[5] copies/mL were treated with interferon-alpha-2b [Pdferon: Pooyesh Darou, Tehran, Iran] for 52 weeks as 5 MU Sc. For 24 weeks in HbeAg[+] and 48 weeks for HbeAg[-] at baseline of study in Tehran, Iran. Serum HBV-DNA level using Cobas Amplicor HBV Monitor test and HbeAg status were assessed at baseline and end of 6-months follow-up. Sustained response [SR] [n=42, 56%] was defined by HbeAg seroconversion [n=12], or with a decrease in HBV-DNA >10[5] copies/mL to undetectable value [n=33], or chemical response [n=20]. Higher pretreatment HBV-DNA levels have a significant relationship with better response to treatment in HbeAg [+] [R=0.7, p=0.04]. Positivity of HbeAg in SR was a better predictor of chemical response in our patients, when compared to HbeAg negative [SR: 85% vs. 15%, respectively]. At end of follow up, HbeAg [-] patients revealed more decrease in HBV-DNA levels than HbeAg [+] [412 vs. 290 _10[5] copies/ml, p<0.05]. Sensitivity of HBV-DNA in HbeAg [+] was more than HbeAg[-] [75% vs. 62%], but specificity was less in HbeAg[+] [58% vs. 45%]. Area under ROC was 0.63 in HbeAg [-]. Higher pretreatment HBV-DNA levels have a significant relationship with better response to treatment in HbeAg positive patients of CHB. Although HBV-DNA in HbeAg negative was decreased significantly from baseline to end of follow-up, monitoring with sensitive quantitative baseline HBV-DNA measurement in these patients was not a better predictor of SR than HbeAg positive