Hepatitis B Cure Standards: Key Markers Beyond E Antibody

Criteria for Hepatitis B Cure

Hello Dr.
Chen,
In July 2007, I had a test for Hepatitis B e-antigen (HBeAg) at Kaohsiung County Gousheng Hospital, which showed a value of 1272.
At the end of January this year, I had a follow-up test at Kaohsiung Veterans General Hospital, and the HBeAg was 418.
In early March, the HBeAg was 260, and last week, the follow-up test showed HBeAg was less than 1.
During the three follow-up tests from January to last week, both GPT (ALT) and GOT (AST) were slightly elevated.
I was on a long-term prescription medication at that time.
Last week, the physician at Kaohsiung Veterans General Hospital indicated that the HBeAg is now negative, but the Hepatitis B e-antibody (anti-HBe) is still negative, so I need to continue monitoring for the presence of the anti-HBe.

Dr.
Chen, could you please clarify what other criteria, besides a positive anti-HBe and a negative Hepatitis B surface antigen (HBsAg), are used to determine the resolution of Hepatitis B?

A-Jin, 30~39 year old female. Ask Date: 2009/07/16

Dr. Chen Shidian reply Gastroenterology and Hepatology

In general, surface antigens will remain positive for life and cannot be completely cured.
If there are E antibodies and a self-paid test for HBV DNA shows low viral load, the individual is considered to be in a low-risk group; however, monitoring should still be conducted every six months.

Reply Date: 2009/07/16

More Info

In the context of Hepatitis B (HBV) management, understanding the markers of infection and recovery is crucial for both patients and healthcare providers. The primary markers used to assess the status of Hepatitis B infection include the Hepatitis B surface antigen (HBsAg), Hepatitis B surface antibody (anti-HBs), Hepatitis B e antigen (HBeAg), and Hepatitis B e antibody (anti-HBe).
To determine the standards for "cure" or resolution of Hepatitis B, it is essential to consider several key markers:
1. HBsAg (Hepatitis B Surface Antigen): The presence of HBsAg indicates an active HBV infection. A negative HBsAg result is a critical marker for determining that the virus is no longer present in the body, suggesting that the infection has resolved.

2. anti-HBs (Hepatitis B Surface Antibody): The presence of anti-HBs indicates recovery from HBV infection and immunity to future infections. A positive anti-HBs result, particularly in conjunction with a negative HBsAg, is a strong indicator of successful resolution of the infection.

3. HBeAg (Hepatitis B e Antigen): The presence of HBeAg indicates active viral replication and higher infectivity. A negative HBeAg result, especially when combined with a positive anti-HBe, suggests a lower level of viral activity and a reduced risk of transmission.

4. anti-HBe (Hepatitis B e Antibody): The presence of anti-HBe indicates that the body has developed an immune response to the e antigen, which is a positive sign in the context of chronic HBV infection. It often correlates with a decrease in viral replication.

5. HBV DNA Levels: Quantitative measurement of HBV DNA is crucial in assessing the viral load. A low or undetectable HBV DNA level indicates that the virus is not actively replicating, which is an important aspect of determining the effectiveness of treatment and the potential for cure.

6. Liver Function Tests (LFTs): Monitoring liver enzymes such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST) is essential. Normalization of these enzymes suggests that the liver is not under significant stress from the virus, which is an important aspect of recovery.

In your case, the progression from a high E antigen level to a negative result is a positive sign, indicating a decrease in viral activity. However, the fact that the E antibody is still negative suggests that further monitoring is necessary. The presence of elevated liver enzymes (GPT and GOT) during this period indicates that while the viral load may be decreasing, there may still be some liver inflammation or damage that needs to be addressed.

It is also important to note that while achieving a negative HBsAg and positive anti-HBs is a strong indicator of recovery, some patients may continue to have detectable HBsAg for a prolonged period even after the infection has resolved. This is particularly true in cases of resolved infections where the patient has developed immunity.

In conclusion, the standards for determining the resolution of Hepatitis B infection extend beyond just the E antibody and surface antigen. A comprehensive assessment involving HBsAg, anti-HBs, HBeAg, anti-HBe, HBV DNA levels, and liver function tests is essential for evaluating the patient's status and guiding further management. Regular follow-up and monitoring are crucial to ensure that any changes in these markers are appropriately addressed.

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