The relevance of a particular HBsAg level in the context of viral activity and disease progression is uncertain. Although a 0.5 log or 1.0 log reduction of HBsAg has been proposed as on-treatment predictors of response to peginterferon, the magnitude of HBsAg fluctuation in untreated individuals has not been evaluated.11 Before a particular HBsAg level or a magnitude of change in HBsAg level can be recommended to predict treatment outcome, one must first understand the meaning of these parameters in the treatment-free Cisplatin datasheet setting. In this study, based on a cohort of untreated patients with chronic

hepatitis B with long-term follow-up, we aimed to investigate the HBsAg levels at different stages of chronic hepatitis B. We also aimed to investigate the changes

in HBsAg level during the natural progression of disease. Our results would provide important information on the meaning of serum HBsAg quantification in relation to the natural history of chronic hepatitis B. ALT, alanine aminotransferase; cccDNA, covalently closed circular DNA; HBeAg, hepatitis B e antigen; HBsAg, hepatitis B surface antigen; HBV, hepatitis B virus. One hundred seventeen patients with chronic hepatitis B in the cohort recruited since 1997 with longitudinal follow-up in the outpatient clinic, Prince of Wales Hospital, Hong Kong, China, were studied.13 All patients received Selleckchem CHIR 99021 no antiviral therapy during the entire follow-up period. Coinfection by hepatitis C virus was excluded. These patients were followed at an interval of 6 months, or more frequently as clinically indicated. Hepatitis B e antigen (HBeAg) and antibody, liver biochemistry, and alfa-fetoprotein were monitored

at every visit. Residual serum samples were stored at −80°C for HBV DNA and HBsAg quantification. Patients were classified into five groups for analysis. MCE Group 1 consisted of patients with persistently positive HBeAg and normal alanine aminotransferase (ALT), i.e., patients in the immune tolerance phase. Group 2 consisted of patients who had positive HBeAg at the first visit and persistently positive or fluctuating HBeAg during follow-up with intermittent elevation of ALT levels, i.e., unsuccessful immune clearance. Group 3 consisted of HBeAg-positive patients who underwent sustained HBeAg seroconversion. Group 4 consisted of HBeAg-negative patients with intermittent elevation of ALT levels and/or HBV DNA > 2000 IU/mL, i.e., HBeAg-negative active chronic hepatitis B. Group 5 consisted of patients who were HBeAg-negative with persistently normal ALT with HBV DNA ≤ 2000 IU/mL throughout the entire follow-up, i.e., HBeAg-negative inactive chronic hepatitis B. For Groups 1, 2, 4, and 5, HBV DNA and HBsAg were measured at the first visit, the last visit, and visits at each quartile during the follow-up (second, third, and fourth visit).