BACKGROUND AND AIMS: The precise identification of true inactive hepatitis B carrier is difficult due to frequent fluctuations in Hepatitis B virus (HBV) DNA and serum transaminase levels, needing serial determinations for a period of at least one year. Hence we correlated the hepatitis B surface antigen (HBs Ag) titer of untreated Hepatitis B e Antigen (HBe Ag)-negative patients with their corresponding HBV DNA and alanine aminotransferase (ALT) levels, classified these patients as either inactive carrier or patients in the reactivation phase using the American Association for the Study of Liver Diseases (AASLD) guidelines and finally determined if there was a significant difference in HBs Ag titer between these groups.
METHODS: A cross sectional retrospective study was done. All HBe Ag- negative Chronic hepatitis B (CHB) patients who had their HBs Ag titer, HBV DNA and ALT done at National Kidney and Transplant Institute (NKTI) were obtained and clinical information was abstracted from their case records. A total of 40 patients were included in the study.
RESULTS: The mean HBs Ag titer among untreated HBe Ag negative CHB patients was 3037.04 IU/mL (SD +/- 8718.94 IU/mL). Using Spearman's coefficient of correlation, HBs Ag was found to be directly correlated with HBV DNA (R = 0.821, p = 0 < 0.05) and serum ALT (R = 0.654, p = 0 < 0.05). Moreover, using Mann Whitney T Test, the mean difference in HBs Ag titer between inactive carrier group (mean 103.72 IU/mL, SD +/- 144.25) and reactivation phase group (mean 5690.99 IU/mL, SD +/- 11517.39) was significant (p value = 0 < 0.05).
CONCLUSION: HBs Ag titer was found to be directly correlated with HBV DNA and ALT. To our knowledge, this is the first local study done that supports the concept that HBs Ag titer can provide complementary information in differentiating patient as true inactive carrier from those in the reactivation phase.