Hepatitis B Surface Antigen Levels Can Be Used to Rule Out Cirrhosis in Hepatitis B e Antigen-Positive Chronic Hepatitis B: Results from the SONIC-B Study

Milan J. Sonneveld, Bettina E. Hansen, Willem P. Brouwer, Henry L.Y. Chan, Teerha Piratvisuth, Ji Dong Jia, Stefan Zeuzem, Rong Nan Chien, Robert J. De Knegt, Cynthia Wat, Vedran Pavlovic, Anuj Gaggar, Qing Xie, Maria Buti, Robert A. De Man, Harry L.A. Janssen*

*Corresponding author for this work

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Abstract

Background: Serum hepatitis B surface antigen (HBsAg) levels correlate with the duration of chronic hepatitis B virus (HBV) infection and may predict the extent of hepatic fibrosis. Methods: We analyzed data from the SONIC-B database, which contains data from 8 global randomized trials and 2 large hepatology centers. Relationship between HBsAg levels and presence of significant fibrosis (Ishak 3-4) or cirrhosis (Ishak 5-6) were explored, and clinically relevant cutoffs were identified to rule out cirrhosis. Results: The dataset included 2779 patients: 1866 hepatitis B e antigen (HBeAg)-positive; 322 with cirrhosis. Among HBeAg-positive patients, lower HBsAg levels were associated with higher rates of significant fibrosis (odds ratio [OR], 0.419; P <. 001) and cirrhosis (OR, 0.435; P <. 001). No relationship was observed among HBeAg-negative patients. Among HBeAg-positive patients, genotype-specific HBsAg cutoffs had excellent negative predictive values (>97%) and low misclassification rates (≤7.1%) and may therefore have utility in ruling out cirrhosis. Diagnostic performance of the HBsAg cutoffs was comparable among patients in whom cirrhosis could not be ruled out with fibrosis 4 (FIB-4). Conclusions: Hepatitis B virus genotype-specific HBsAg cutoffs may have utility in ruling out presence of cirrhosis in HBeAg-positive patients with genotypes B, C, and D and can be an adjunct to FIB-4 to reduce the need for further testing.

Original languageEnglish
Pages (from-to)1967-1973
Number of pages7
JournalJournal of Infectious Diseases
Volume225
Issue number11
DOIs
Publication statusPublished - 1 Jun 2022

Bibliographical note

Publisher Copyright:
© 2020 The Author(s). Published by Oxford University Press for the Infectious Diseases Society of America.

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