Hepatitis B core-related antigen serum levels may be a predictor of acute flare of chronic hepatitis B among pregnant women in the immune-tolerant phase of chronic HBV infection after short-course antiviral therapy

ABSTRACTBackground Studies have shown liver aminotransferase level is apparently increased in about 50% of pregnant women with chronic hepatitis B virus (HBV)-infection, which includes acute flares of chronic hepatitis B (CHB). These acute flares of CHB are bound up with immunologic changes that arise during pregnancy and could result in liver dysfunction, hepatic decompensation and even maternal death. However, the indicators for predicting acute flares of CHB among pregnant women still need further study. We are intended to distinguish the relevance between serum levels of hepatitis B core-related antigen (HBcrAg) and acute flares of CHB in pregnant women in the immune-tolerant phase of chronic HBV infection after short-course antiviral therapy.Methods A total of 172 chronic HBV-infected pregnant women who were judged to be in the immune-tolerant phase were recruited in our research. All patients received short-course antiviral therapy with tenofovir disoproxil fumarate (TDF). Standard laboratory procedures were performed to measure the biochemical, serological, and virological parameters. The serum level of HBcrAg was tested by ELISA.Results Eighty (46.5%) out of 172 patients had elevated ALT levels, and 52 (30.2%) out of 172 patients had acute flares of CHB. Compared to baseline, ALT and AST increased significantly at postpartum week 12, postpartum week 16, postpartum week 24 and postpartum week 36 (p< 0.01). Compared with baseline, HBcrAg levels were significantly decreased at delivery and at postpartum week 12 (TDF cessation) after TDF antiviral treatment (p< 0.01). Compared with postpartum week 12, the HBcrAg levels of postpartum week 16, postpartum week 24 and postpartum week 36 increased significantly (p< 0.01). At postpartum week 12, HBcrAg levels of acute flare of CHB patients were higher than those of no acute flare of CHB patients (p< 0.01). Serum HBcrAg (OR, 4.52; 95% confidence interval [CI], 2.58–7.92) and HBsAg (OR, 2.52; 95% CI, 1.13–5.65) were associated with acute flares of CHB. The serum HBcrAg levels were beneficial for confirmation of patients with acute flares of CHB, with an area under the ROC curve of 0.84 (95% CI, 0.78–0.91).Conclusions For pregnant women with chronic HBV infection in the immune-tolerant phase, serum HBcrAg and HBsAg levels at postpartum week 12 (TDF cessation) were associated with acute flares of CHB after short-course antiviral therapy with TDF. The serum HBcrAg level can correctly identify acute flares of CHB and may be a predictor of the need for continuing antiviral therapy after 12 weeks postpartum.