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PTU-107 Defining the low-risk inactive carrier in chronic hepatitis b with qhbsag: do the same rules apply in children and young adults?
  1. N Hansi1,
  2. US Gill1,
  3. M Banerjee2,
  4. S Naik3,
  5. W Tong4,
  6. GR Foster1,
  7. I Carey5,
  8. PT Kennedy1
  1. 1Hepatology, Blizard Institute, Barts and the London SMD, QMUL, London
  2. 2School of Medicine, University of Liverpool, Liverpool
  3. 3Paediatric Gastroenterology and Hepatology
  4. 4Virology, Barts Health NHS Trust
  5. 5Institute of Liver Studies, King’s College Hospital, London, UK


Introduction A substantial proportion of e-Antigen negative chronic hepatitis B (CHB) under specialist follow-up are inactive carriers (IC) defined as those with low serum ALT and HBV DNA. Recent studies have described the potential utility of quantitative Hepatitis B surface antigen (qHBsAg) (<1,000 IU/ml) to represent a low-risk IC state, which is associated with reduced risk for disease progression and the development of HCC. Conversely higher qHBsAg levels (>1,000 IU/ml) are associated with an increase in risk of disease progression.1Accurate identification of low-risk IC’s would reduce the frequency of follow-up and the need for HCC screening in selected patients. We investigated whether a qHBsAg threshold (<1,000 IU/ml) representing a low-risk IC profile can be applied to children and young adults with CHB.

Method Fifty-six consecutive treatment naïve eAg negative young patients (<30 years) considered IC’s (ALT <40, HBV DNA <2,000 IU/ml) over longitudinal follow-up were analysed; female = 38, median age = 26 years (range 12–30 years). A cohort of older patients (>30 years) based on the same parameters were included for comparison; female = 33%, median age = 42 years (range 31–61 years). HBsAg levels were quantified in all patients to determine any correlation between the qHBsAg threshold (<1,000 IU/ml) and age.

Results In keeping with an IC disease profile, serum ALT and HBV DNA levels in both cohorts were similar (p = ns), however, qHBsAg levels were significantly higher in the <30s vs. >30s; mean qHBsAg 10,545 IU/ml vs. 5,278 IU/ml (p = 0.006). In accordance with this we detected a significant negative correlation with age and qHBsAg (Spearman Rho rs = -0.35, p = 0.0004). A significantly higher proportion of older patients had qHBsAg <1,000 IU/ml, (36% vs. 13%, p = <0.001), consistent with low-risk IC state.

Conclusion The addition of qHBsAg to serum ALT and HBV DNA can enhance risk stratification. However, a threshold level (<1,000 IU/ml) cannot be safely utilised in young patients to define a low-risk IC state. The natural decline in qHBsAg with advancing age underlines the need for further studies to define an age limit above which this qHBsAg level (<1,000 IU/ml) can be used to identify low-risk ICs and streamline clinical monitoring.

Disclosure of interest None Declared.


  1. Tseng TC, Liu CJ, Yang HC, et al. High levels of hepatitis B surface antigen increase risk of hepatocellular carcinoma in patients with low HBV load. Gastroenterology 2012;142:1140–1149

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