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. 2017 Apr;24(4):320-329.
doi: 10.1111/jvh.12643. Epub 2016 Dec 5.

Determination of hepatitis B phenotype using biochemical and serological markers

A M Di Bisceglie  1 , M Lombardero  2 , J Teckman  1 , L Roberts  3 , H L A Janssen  4 , S H Belle  2 , J H Hoofnagle  5 ; Hepatitis B Research Network (HBRN)
Collaborators, Affiliations

Determination of hepatitis B phenotype using biochemical and serological markers

A M Di Bisceglie et al. J Viral Hepat. 2017 Apr.

Abstract

The aim of this study was to assess the validity of categorization of chronic hepatitis B viral infection into stages or phases based upon measures of disease activity and viral load, assuming these phenotypes will be useful for prognostication and determining the need for antiviral therapy. We assessed the phenotype of hepatitis B of 1,390 adult participants enrolled in the Hepatitis B Research Network Cohort Study, using a computer algorithm. Only 4% were immune tolerant, while 35% had chronic hepatitis B (18% e antigen positive and 17% e antigen negative) while 23% were inactive carriers. Strikingly, 38% of participants did not fit clearly into any one of these groups and were considered indeterminant. The largest subset of indeterminants had elevated serum aminotransferases with low levels of HBV DNA (less than 10,000 iu/mL). Subsequent determination of hepatitis B phenotype on the next available laboratory tests showed that 64% remained indeterminant. These findings call into question the validity of conventional staging of hepatitis B, in large part because of the substantial proportion of patients who do not fit readily into one of the usual stages or phases. Further studies are needed of the indeterminant category of chronic hepatitis B viral infection, including assessments of whether patients in this group are perhaps in transition to another phase or if they are a distinct phenotype with a need to assess liver disease severity and need for antiviral therapy. (ClinicalTrials.gov identifier NCT01263587).

Keywords: algorithm; hepatitis B; phases; phenotype; stages.

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Conflict of interest statement

DISCLOSURES

No authors have any relevant financial disclosures or other conflicts of interest.

Figures

Figure 1
Figure 1
A: Scatterplot and moving average of baseline ALT values and HBV DNA levels for 356 HBeAg-positive adult participants B: Scatterplot and moving average of baseline ALT values and HBV DNA levels for N=1034 HBeAg-negative adult participants
Figure 2
Figure 2
A: Scatterplot of baseline ALT values and HBV DNA levels for 187 HBeAg positive adult female participants B: Scatterplot of baseline ALT values and HBV DNA levels for 169 HBeAg positive adult male participants
Figure 3
Figure 3
A: Scatterplot of baseline ALT values and HBV DNA levels for 493 HBeAg negative adult female participants B: Scatterplot of baseline ALT values and HBV DNA levels for 541 HBeAg negative adult male participants
See this image and copyright information in PMC

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