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Commentary on the Article “Hepatitis B Surface Antigen and DNA Quantification among e Negative Chronic HBV Infected Patients in Two Nigerian Hospitals”

Introduction

The study “Hepatitis B Surface Antigen and DNA Quantification among e Negative Chronic HBV Infected Patients in Two Nigerian Hospitals,” published in JSM Hepatology by Kolawole O. Akande and Adegboyega Akere, offers a comprehensive examination of the patterns of Hepatitis B surface antigen (HBsAg) and DNA quantification in e-negative chronic Hepatitis B virus (HBV) infected patients. This commentary aims to analyze the study’s methodology, findings, and implications for clinical practice, particularly in the context of Sub-Saharan Africa.

Study Overview

Objective: The study aimed to describe the patterns of quantitative HBsAg and HBV DNA among e-negative chronic HBV patients and to explore any potential correlation between these two markers.

Methods: The researchers conducted a cross-sectional study involving 121 asymptomatic, treatment-naive e-negative chronic HBV patients from two hospitals in Nigeria. Quantitative analyses of HBsAg and HBV DNA were performed on serum samples.

Results:

  • Demographics: Of the 121 patients, 62% were male, and 38% were female, with ages ranging from 18 to 68 years.
  • HBsAg Quantification: Levels ranged from 0.25 to 52,000 IU/ml, with a median of 5289 IU/ml and a mean of 3.33 ± 1.32 log10 IU/ml. Notably, 77% of patients had HBsAg levels ≥ 1000 IU/ml.
  • HBV DNA Quantification: Levels ranged from 15 to 26,000 IU/ml, with a median of 560 IU/ml and a mean of 2.67 ± 1.24 log10 IU/ml. Interestingly, 76% of patients had HBV DNA levels < 2000 IU/ml.
  • Correlation: The study found no significant correlation between HBsAg and HBV DNA levels (rho=0.13, p=0.13).

Analysis

Strengths
  1. Comprehensive Data Collection: The study’s strength lies in its comprehensive data collection from a significant number of treatment-naive patients. This provides a clear baseline for understanding the natural course of e-negative chronic HBV in the studied population.
  2. Focus on Sub-Saharan Africa: Given the high prevalence of HBV in Sub-Saharan Africa, this study provides valuable insights specific to this region, which is often underrepresented in global health research.
Limitations
  1. Cross-Sectional Design: The cross-sectional nature of the study limits the ability to infer causality or changes over time. Longitudinal studies would be beneficial to track the progression of HBV and its response to potential treatments.
  2. Lack of Long-Term Follow-Up: Without long-term follow-up, it is difficult to determine the clinical outcomes related to the varying levels of HBsAg and HBV DNA.
Clinical Implications
  1. Treatment Thresholds: The study suggests that a high percentage of patients with low viremia but high HBsAg levels may still be at risk for long-term complications. This raises the question of whether treatment thresholds should be adjusted based on HBsAg levels, even when HBV DNA levels are low.
  2. Predictive Value of HBsAg: The findings support the utility of HBsAg quantification as an additional marker for identifying patients at risk of progression and requiring closer monitoring or earlier intervention.
Recommendations for Future Research
  1. Longitudinal Studies: To better understand the implications of high HBsAg levels in the presence of low HBV DNA, longitudinal studies are needed to track patient outcomes over time.
  2. Broader Population Studies: Expanding the study to include more diverse populations across different regions could help validate the findings and explore potential genetic or environmental factors influencing HBV progression.

Conclusion

The study by Akande and Akere provides valuable insights into the quantification of HBsAg and HBV DNA among e-negative chronic HBV patients in Nigeria. The lack of correlation between HBsAg and HBV DNA levels suggests that these markers independently contribute to the understanding of HBV infection severity and progression. This highlights the need for a nuanced approach to HBV management, particularly in high-prevalence regions like Sub-Saharan Africa.

References:

  1. Akande KO, Akere A. Hepatitis B Surface Antigen and DNA Quantification among e Negative Chronic HBV Infected Patients in Two Nigerian Hospitals. JSM Hepat 2019; 4(1): 1012. DOI: 10.47739/1012.
  2. European Association for the Study of the Liver (EASL). Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol. 2017.