qHBsAg during treatment with NUCs and Interferon

[StephenCastlecrag]

http://www.saudijgastro.com/article.asp?issn=1319-3767;year=2012;volume=18;issue=2;spage=81;epage=86;aulast=Vigan%F2
Clinical implications of HBsAg quantification in patients with chronic hepatitis B

Mauro Viganò1, Pietro Lampertico2
1 Hepatology Unit, Ospedale San Giuseppe, Università degli Studi di Milano, Milano, Italy
2 1st Division of Gastroenterology, Fondazione Cà Granda IRCCS Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italy

Quantification of serum hepatitis B surface antigen (HBsAg) helps the management of patients with chronic hepatitis B virus (HBV) infection. Median HBsAg levels differ significantly during the natural history of HBV infection, progressively declining from immune tolerance to inactive phase. The combination of an HBsAg <1000 IU/mL and HBV DNA <2000 IU/mL at a single time point accurately identifies true inactive carriers. During antiviral treatment, HBsAg levels decline more rapidly in patients under peg-interferon (Peg-IFN) than in those under nucleos(t)ide analogues (NUC), and in responders to peg-IFN compared to non responders suggesting that a response-guided therapy in both HBeAg-positive and -negative patients treated with Peg-IFN could improve to cost-effectiveness of this therapeutic approach. Given the low rates of HBsAg clearance on NUC therapy, new studies to test whether Peg-IFN and NUC combination fosters HBsAg decline in long-term responders to NUC, are being explored.

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This is a very interesting review on the level of HBsAg during various treatments. The full article is available from the link. We still have a way to go in understanding how NUCs affect qHBsAg.

[4est]

interesting that we have a correlation from a interferon and qHBsAg.

[veteranB]

Guys they knew it all along. That interferon is better. How do you think in the 70and 80s they used to treat it?

[stef2011]

it starts to go down within 3-6 months with biggest decrease between 6-12 months
any decline close to less than 1000iu/ml geno D is good because there is more immune control, i d not care too much about infected cells but to the effect of unblocking immune system when hbsag goes down

i have not posted but there is also a study with correlation of hbsg level and intf gamma in the liver, it rises already at hbsag levels below 5000iu/ml with highest intf gamma below 1000iu/ml

[StephenCastlecrag]

Sorry, I missunderstood.  You are right, qHBsAg can rise initially, as pointed out by stef2011 with Interferon treatment. Mostly, the review concentrated on trends over a period of time. To me, there are still many questions such as when qHBsAg  goes down, does it mean less infected cells, or less transcriptions? What control the amount of HBsAg produced within a cell?

[4est]

i'm not referring to any S-antigen mutants, or at least this was  the intention.
As far as I know qHBsAg is not stable and in some cases it can fluctuate (go up and down) and from the article I understand that they say that usually qHBsAg go down without any fluctuation.

I don't know if the fluctuation occurred naturally or occurred only in people under treatment and also it was not my intention to discuss S-antigen mutants

[StephenCastlecrag]

You mean some S-antigen mutants that are not included in the current method to measure qHBsAg?
The article is a review and it summarizes what is known today. Obviously we need to find out more. I wonder why Lamivudine and Telbvudine cause a greater loss of qHbsAh but the effect is not sustained.

[4est]

indeed is relay interesting, but from article we can understand that qHBsAg is always decreasing (slower or faster) but I've read some cases that had a variation of qHBsAg  and this is somehow not explained.

[Jeff912000]

Great article.