Most patients with chronic hepatitis B virus (HBV) will lose the HBe antigen (HbeAg) and will develop anti-HBe antibodies.
The overall effect will be undetectable HBV DNA, normal ALT levels, ordinary liver biopsies, low risk for progression to cirrhosis and low risk for progression to hepatocellular carcinoma (HCC).
On the other hand, patients with HbeAg-negative chronic hepatitis (these are the active carriers) will retain HBV DNA and maintain elevated ALT results.
In addition, their liver biopsies will show necrotic inflammation, they are at a higher risk for progression to end-stage liver disease and at a higher risk for progression to development of HCC.
In a recent publication in the April issue of Gut (an International Journal of Gastroenterology and Hepatology), researchers from the Hippokration General Hospital of Athens reported that serum apoptotic caspase activity is strongly associated with the presence of liver injury in patients with HbeAg-negative chronic HBV infection.
Through Elisa, the authors were able to measure levels of cytokeratin-18 (CK-18) fragments as markers for apoptotic caspase activity.
The study also reports that CK-18 activity is useful in differentiating between inactive chronic HBV carriers and patients with HBeAg-negative chronic hepatitis B.
