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Serum HBcrAg status indicates HBV prophylactic therapy candidates

A patient’s hepatitis B core-related serum status may help clinicians determine if prophylactic HBV antiviral therapy is right for them, according to a published report. 

“There has always been a debate on the most suitable management strategy: a blanket policy of prophylactic antivirals versus routine monitoring of HBV disease status,” Wai-Kay Seto, MD, of the department of medicine at Queen Mary Hospital, The University of Hong Kong, told Healio.com/Hepatology. “Our study attempts to stratify the risk profile of such patients via the measurement of the hepatitis B core-related antigen, or HBcrAg.”

Wai-Kay Seto

Seto and colleagues evaluated 124 Asian patients who were HBsAg-negative and anti–HBc-positive; half received Rituxan (rituximab, Genentech/Biogen Idec) and the other half underwent allogeneic hematopoietic stem cell transplantation (HSCT). The patients were examined every 4 weeks for up to 2 years.  

Researchers found HBV recurred in 31 patients with a 2-year reactivation rate of 40.4% among both groups. Serum HBcrAg was detected in 43 patients among the groups as well. Those with baseline HBcrAg positivity were nearly three times as likely to experience HBV recurrence (HR = 2.94; 95% CI, 1.43–6.07).

“Patients with a positive HBcrAg were noted to be at a significantly higher risk of HBV reactivation when compared to HBcrAg-negative patients,” Seto told Healio.com/Hepatology.

Seto noted that 13% to 68% of the East Asian population has been exposed to HBV, putting them at risk for HBV recurrence during immunosuppressive therapy. While past exposure to HBV could explain the positive serum anti-HBc readings, it cannot be used to distinguish patients with previous self-limiting HBV exposure, according to the research.

Differentiating between positive and negative patients may be difficult since a majority of HBsAg-negative, anti–HBc-positive patients have undetectable serum HBV DNA. However, Seto said HBcrAg measurements would help clinicians separate their patients into either a positive or negative group and better manage their treatment. He also said HBcrAg-positive patients may be more suitable for antiviral therapy compared with HBcrAg-negative patients.

“HBcrAg-positive patients, given their higher risk of HBV reactivation, might be suitable candidates for prophylactic antiviral therapy, while HBcrAg-negative patients, given their relatively lower risk, might be more suitable for routine monitoring,” Seto told Healio.com/Hepatology. “This risk stratification would optimize the management and monitoring of patients undergoing high-risk immunosuppressive therapy in HBV-endemic regions.” – by Janel Miller

Disclosures: Seto reports being on the advisory board and receiving speaking fees from Gilead Sciences and Bristol-Myers Squibb. Please see the study for a list of all other researchers’ relevant financial disclosures.