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Academic year: 2021

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Conclusion

60

6. CONCLUSION

In conclusion, our study shows that HBsAg serum levels vary during

the different phases of chronic HBeAg-negative HBV genotype D

infection and are below 1000 IU/mL in over 90% of IC, but only in

5.7% of patients with CHB. The HBV DNA/HBsAg ratios declined

following the sustained immune-control of HBV infection. Mixed PreS

mutant/wild-type viral population circulate in 1/3 of patients with

significant liver disease (chronic carriers or cirrotics), but rarely in

inactive carriers and in carriers with low viremia (<20,000 IU/ml),

therefore their low HBsAg serum levels do not depend on PreS

mutation. The most common mutations involve the MHC-class I/II-

restricted T-cell epitope and are associated with age and disease stage,

thus suggesting their selection by the host's immune response. All

these findings support the hypothesis that HBsAg serum levels,

reflecting the rate the transcriptionally active cccDNA and their

quantification add further information to the monitoring of viral

replication in the understanding of the complex equilibrium between

the virus and the host’s immune response at the single carrier level.

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