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Hepatitis B virus (HBV) infection is a major global health problem. It can cause chronic infection and put people at high risk of death from cirrhosis and liver cancer. This study aims to present a case of chronic hepatitis B flare in a very young adult patient. An 18-year-old previously healthy female presented with jaundice developing in one week, following the previous complaints of nausea, vomiting, abdominal pain, loss of appetite, and tiredness for about three months. The patient had no risk factors for getting HBV infection, but her HBsAg-positive mother was probably an inactive HBV carrier. The hepatitis B serological testing revealed HBsAg positivity, anti-HBs seronegativity, HBeAg positivity, anti-HBe seronegativity, anti-HBc IgM seronegativity, and high levels of HBV DNA detected > 1.70 × 108 IU/mL. There was a sharp increase in serum ALT to ≥ 5-fold ULN. The abdominal ultrasonography revealed a hepatitis feature, unremarkable portal venous flow, and an extrahepatic biliary system. The liver transient elastography revealed 15.6 kPa of liver stiffness, which was in accordance with the F3-F4 fibrosis stage. These features were typical of a hepatitis B flare, the HBeAg-positive chronic hepatitis B, previously known as the immune reactive phase. A long-term nucleos(t)ide analog therapy was programmed with Tenofovir alafenamide 25 mg daily.

Background: HBV DNA assays have several limitations including being expensive and not widely available. Detection of HBsAg in serum has been the hallmark of HBV infection. However, previous studies regarding the association between HBsAg and HBV DNA revealed contradictory results. This study aims to reassess the correlation between HBsAg and HBV DNA in chronic hepatitis B patients. Methods: Observational studies with näive chronic hepatitis B patients were included, while studies with other coinfections were excluded. The studies were identified by searching through Google Scholar, PubMed, ScienceDirect, and Springer Link for English and Bahasa articles from 2011 to 2021. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) was followed. Study quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal. Results: A total of 17 studies with 4134 participants met the criteria. The overall analysis revealed a moderate correlation between quantitative HBsAg and quantitative HBV DNA in the total sample of chronic hepatitis B patients (r = 0.57, 95% CI 0.40–0.75, P < 0.00001). In HBeAg + group, a moderate correlation was indicated while in HBeAg − revealed a weak association (r = 0.55, 95% CI 0.39–0.70, P < 0.00001 vs r = 0.29, 95% CI 0.20–0.38, P < 0.00001). The strongest correlation was discovered in HBeAg + chronic HBV infection phase (r = 0.59, 95% CI 0.35–0.82, P < 0.00001). Conclusion: Serum HBsAg titer supports as a predictor of serum HBV DNA levels in clinical practice with moderate strength of correlation. Trial registration: This review had been registered in PROSPERO (ID: CRD42023421246). [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the profile of qHBs Ag profile, and also to investigate the correlation between qHBs Ag and HBV DNA. Seventy samples of chronic-naïve hepatitis B patients in Dr. Soetomo Hospital were analyzed in a cross-sectional study. Patients were categorized according to the HBe Ag positive (n=30) and HBe Ag negative (n=18), also based on qHBs Ag 1000 IU/mL and qHBs Ag >1000 IU/mL. qHBs Ag was correlated with HBV DNA. qHBs Ag by CLEIA method from Sysmex, KOBE HISCL, HBV DNA was measured by real-time Polymerase Chain method from Gene Xpert, Cepheid. 70 patients naïve CHB treatment showed a median of ALT level 60.21±70.76 U/L. 30 patients showed a positive-HBeAg, 18 patients showed negative-HBeAg, 22 patients were not evaluated (N/A). Positive-HBeAg patients had 70% qHBsAg >2500 mg/dL and median HBV DNA 7.49×107 IU/mL. Negative-HBeAg patients had 55.6% HBsAg ≤1000 mg/dL and median HBV DNA 9.66×102 IU/mL. qHBsAg correlated with HBV DNA (p <0.001). This data demonstrated that quantitative HBsAg was associated with a phase of HBV-infection, quantitative HBsAg showed a moderate correlation with DNA HBV, quantitative HBsAg levels might be a predictor of initiation therapy for CHB patients. [ABSTRACT FROM AUTHOR]

Background: Chronic hepatitis B is a global burden disease with the mortality rate of over one million around the world because of the complication. In Indonesia the number of hepatitis B sufferers in a healthy population is estimated to reach 4-20.3%, where the figure is higher outside of Java. This study aims to analyze the description of HBeAg serological status in patients with chronic hepatitis B. Method: a descriptive study using medical records and sera of patients with chronic hepatitis B was used as primary data. The population of this study were patients with chronic hepatitis B in Gastroenterology and Hepatology Center of Dr. Soetomo General Hospital Surabaya in purposive sampling. The number of samples that fulfilled the inclusion and exclusion criteria was 82 people. Result: Most patients are between the ages of 50-59 (29,3%), males (67,1%), HbeAg loss (52,8%) receiving telbivudine (31,5%) and lamivudine (31,5%) as monotherapy for more than two years (42,1%) and have normal ALT (46,3%). Discussion: People with inactive (carriers) chronic HBsAg that are characterized by HBsAg last more than six months, also HBeAg negative, have serum ALT levels within normal limits. A temporary increase in ALT before remission can occur in some patients with chronic HBV infection after one year of treatment interruption. Conclusion: Telbivudine and lamivudine, separately as monotherapy, demonstrated greater HBeAg loss which reached within more than two years therapy. [ABSTRACT FROM AUTHOR]

The prevalence of hepatitis B infection in Indonesia is still alarming, while its therapies cannot eradicate the virus and only aim for long term viral suppression. Hepatitis B surface antigen (HBsAg) quantification has become an emphasis on researches, regarding its capacity to identify the natural history of hepatitis B virus infection and predict the outcome of therapies. This review aims to determine the clinical role of HBsAg in chronic hepatitis B infection by reviewing textbooks, journal articles, and review articles without language restriction. This review finds that HBsAg is capable of predicting degrees of liver fibrosis severity in patients with chronic hepatitis B infection. Furthermore, HBsAg quantification can be used to distinguish inactive carriers from patients with HBeAg-negative chronic hepatitis B. The decrease of HBsAg is a good predictor of HBsAg loss, and it denotes discontinuation of nucleoside/nucleotide analog therapy. HBsAg quantification is also used in combined pegylated interferon (PEG-IFN) and nucleoside/nucleotide analog therapy. Nevertheless, this role is still controversial. Additionally, HBsAg cannot replace the major roles of hepatitis B virus deoxyribonucleic acid (HBV DNA) measurement in therapy management. Using either HBsAg or HBV DNA in therapy algorithm decreases its predictive value, hence recommendation to use both. In identifying patients with occult hepatitis B infection (OBI), HBV DNA still cannot be replaced by HBsAg quantification. Furthermore, HBsAg quantification may not be a good predictor of hepatocellular carcinoma in patients with OBI. Future studies are expected to demonstrate the role of HBsAg in current hepatitis B therapy and also future therapies. [ABSTRACT FROM AUTHOR]

Background: Serum hyaluronic acid has an important role in the pathogenesis of liver fibrosis and is one of the most studied extracellular liver matrices. The purpose of this study was to examine the relationship between serum hyaluronic acid level and liver stiffness in hepatitis B chronic patients. Methods: This was an observational cross-sectional analytic study consisting of 43 samples of chronic hepatitis B patients. Serum hyaluronic acid was measured by the ELISA method. Liver stiffness describing fibrosis was examined using Fibro scan. Results: Among forty-three subject was predominantly by females (65.1%). The average age of the study subjects was 44.023 years old. The median serum hyaluronic acid level of the study subjects was 40.318 ng/mL. The median liver stiffness in the study subjects was 5.8 kPa. There was a significant positive correlation between serum hyaluronic acid levels and liver stiffness in the study subjects with a moderate strength of r = 0.448 (P = 0.003). Conclusion: Serum hyaluronic acid levels associated with liver stiffness. [ABSTRACT FROM AUTHOR]