Hi @et5656
The question is that the levels of HBsAg is associated with disease progression in CHB patients with NUCs treatment and suppression of HBV DNA .
If we consider only HBsAg which mostly produced from ccc DNA in HBeAg +ve patients and integrated HBV DNA in HBeAg -ve patients , currently, there are no studies on the cut off levels of HBsAg that would disease progression unlike HBV DNA which has the cut off level at > 2,000 IU/ml . this may be due to the fact that.HBsAg it’s not only produced from cccDNA , it can be produced from integrated HBV DNA therefore HBsAg don’t vary with the phases of CHB as HBV DNA level.
For HBeAg +ve CHB patients, there will be an increase in transcriptional activity of cccDNA leading to increase inHBV DNA level meanwhile increasing HBsAg at the same time. When the body immune system need to eliminate.HBV results in necroinflammatory processes need to fibrosis with scarring formation, cirrhosis and HCC.in CHB patients who are not taking antiviral drug. High HBsAg levels not the direct cause of.necroinflammatory processes, rather it is the high HBV DNA level that caused chronic liver injury and HBV DNA integration. This is consistent with previous studies about HBsAg levels and disease outcomes in CHB patients without antiviral therapy. However, CHB patients with NUCs treatment and have high HBsAg levels and undetectable HBV DNA may have reduce risk of cirrhosis and HCC but can’t complete eliminate risk to zero .
If we consider HBsAg is not carcinogenic , there may be other factors that contribute to cirrhosis and HCC in these patients . In the past, research studies about CHB patients taking antiviral drugs might not control some confounding factors such as MASLD , obesity,alcohol , smoking, lifestyle of patients , aflatoxin exposure etc that may affect the outcome about fibrosis, cirrhosis and HCC. Therefore, it would be appropriate to conduct the research to answer the question about impact of high HBsAg levels and disease outcomes in CHB patients with NUCs completely HBV DNA suppression. I hope this may help you.
chul_chan
Chulapong Chanta. MD. Pediatrics.