Serum hepatitis B surface antigen levels predict insignificant fibrosis and non-cirrhosis in hepatitis B e antigen positive patients with normal or mildly elevated alanine transaminase levels

BACKGROUND/AIMS We aimed to evaluate the diagnostic value of serum hepatitis B surface antigen (HBsAg) levels for liver fibrosis in hepatitis B e antigen-positive [HBeAg (+)] chronic hepatitis B (CHB) patients with alanine transaminase (ALT)≤twice upper limit of normal (ULN). METHODS 505 patients who underwent liver biopsies and HBsAg quantitative detections were included. Liver histology was scored using METAVIR scoring system. The area under the receiver-operator curve (AUROC) was used to determine the diagnostic accuracy. RESULTS Of 505 CHB patients, 333 have HBeAg (+), and 172 have HBeAg (-). HBsAg levels and METAVIR fibrosis scores showed strong correlation (r=-0.50, p<0.001) in HBeAg (+) patients, but no correlation in HBeAg (-) patients (r=0.09, p=0.239). HBeAg (+) patients with insignificant fibrosis (F0-1) exhibited higher HBsAg levels than those with significant fibrosis (F2-4) (4.60 vs 4.12 log10IU/ml, p<0.001). HBeAg (+) patients with non-cirrhosis (F0-3) exhibited higher HBsAg levels than those with cirrhosis (F4) (4.48 vs 3.95 log10IU/ml, p<0.001). In this study, the AUROC of HBsAg was 0.86 for diagnosing insignificant fibrosis, and 0.91 for diagnosing non-cirrhosis in HBeAg (+) CHB patients. CONCLUSIONS Serum HBsAg level can identify insignificant fibrosis and non-cirrhosis in HBeAg (+) CHB patients with ALT≤2 ULN, and thus avoid liver biopsy in this population.