The Analysis of the Correlations between Quantitative HBsAG Level, Virological Markers, and Histopathological Findings in Patients with Chronic Hepatitis B

: Introduction: We aimedto analyze the correlations between serum HBsAg quantification (qHBsAg) level and virological properties in chronic hepatitis B (CHB) patients. Materials and Methods: The study was conducted with 53 CHB patients who underwent liver biopsy. Demographic characteristics of patients, biochemical parameters, serum qHBsAg levels, liver biopsy


Introduction:
In the clinical prognosis in Chronic hepatitis B (CHB) patients, the follow-up of hepatitis B surface antigen (HBsAg), hepatitis B envelop antigen (HBeAg)seroconversion, Hepatitis B virus (HBV) DNA, and aminotransferase levels guide the physicians [1] .Early diagnosis of serious liver disease may improve the status of the disease even in patients who develop decompensation with treatment [2] .However, noninvasive tests are insufficient to determine liver disease to a certain level [3] .Thus, new diagnostic methods are required to diagnose liver fibrosis in the early period.Among these methods, there is a rising interest in the clinical determination of serum HBsAg quantification (qHBsAg) inrecent years due to the standardization of automatic systems [4, International Journal of Medical Science and Clinical Invention, vol. 10, Issue 11, November 2023 5] .A correlation was reported between the qHBsAg serum level and livercovalentlyclosedcircular (ccc) DNA [6] .As the understanding of the molecular virology of HBsAg has improved, it was suggested that serum HBsA gconcentration reflected the cccDNA content, which serves as the transcription pattern for the integrated viral genes in liver hepatocytes.It was reported that the measurement of the HBsAg concentration could be a beneficial marker in addition to HBV DNA level and HBeAg in HBV patients under Peginterferon or Nucleotide analog treatment [7,8] .Thus, it was argued that it allows the prediction of the viral replication levels of circulation HBsAgconcentrations to determine disease activity and response to antiviral treatment [9] .In recent studies, it was reported that serum qHBsAg levels may be a good indicator in the evaluation of patient disease activity and response to interferon-based treatment in CHB, and there was a strong correlation between serum qHBsAgandHBV DNA levels [10,11] In a study conducted by Tuaillon et al.,it was observed that there was a weak correlation between qHBsAg and HBV DNA levels [12] .The present study aimed to analyze the correlations between serum qHBsAglevel and virological properties in CHB patients.

Material and method:
CHB patients who underwent liver biopsy at xxxxxxUniversity Faculty of Medicine, Infectious Diseases and Clinical Microbiology Clinicin 2011-2013were included in this retrospective study.

Discussion:
HBsAg is secreted from hepatocytes in the HBeAg-positive and HBeAg-negative phases of disease and can be copied and translated from different sources of the viral genome.Therefore, the quantification of serum HBsAg has gained wide interest in the last decades [13] .qHBsAg levels were recently used to monitor the prognosis or treatment of CHB infection [14] .However, molecular tests are more important in monitoring HBV-DNA-positive patients with no identifiable qHBsAg levels [15] .In a previous study; it was observed that the qHBsAg level was effective in the evaluation of different CHB phases.It was reported that it could help the differentiation of immune tolerance and immune scavenging in HBeAg-positive patients.In HBeAg-negative patients, it was reported that there was a statistically significant correlation between qHBsAg and HBV DNA in CHB patients and spontaneous serum HBsAglosing and inactive disease could be estimated [8] .A statistically significant correlation was reported between quantitative qHBsAg and HBV DNA levels in a study conducted on elderly CHB carriers followed up for five years. [7].
In a limited number of population studies, it has been shown that qHBsAg measurement correlates with HBV DNA and may be a suitable marker for monitoring the effectiveness of HBV treatment [16] .Studies with a larger number of patients, it has been shown that the qHBsAg level could be used to differentiate inactive and active hepatitis B patientsandsince the use of qHBsAg tests are less costly in laboratories where molecular tests cannot be applied, it has been suggested as a more appropriate approach in CHB treatment monitoring [17,18] .In the present study, a negative correlation was determined between qHBsAg and HBV DNA levels and a significant positive correlation between HBeAg positivity and qHBsAg level.
There are certain studies where a stronger negative correlation was reported between qHBsAg level and fibrosis stage in HBeAgpositive and CHB patients [19,20] .Our study confirms the negative correlation between qHBsAg levels and the fibrosis stage from previously reported studies.On the contrary, some studies reported that a positive correlation was found between qHBsAg and HBV DNA, ALT, HAI score, fibrosis score [21,22] .
In conclusion, we found negative correlations between the qHBsAg level and HBV DNA level, fibrosis score, and HAI, and a positive correlation with HBeAg positivity.Most of the studies reported different results about the correlations between qHBsAg level and virological markers and histopathological findings.However, these potential benefits of HBsAg quantification are suitable for only limited populations.Larger-scale studies are required to standardize these findings.