676 EFFECT OF INFLAMMATORY ACTIVITY ON THE LIVER STIFFNESS MEASUREMENT IN CHRONIC HEPATITIS B PATIENTS

Hepatitis B core antigen (HBcAg) and hepatitis B surface antigen (HBsAg) expressions in the liver may reflect the status of the balance between viral replication and the host immune reaction.Aim: We aimed to search the correlation between serum HBV DNA levels and the percentage of positive cells and the staining patterns of HBsAg and HBcAg on liver biopsy specimens (LBS).Patients and Methods: 162 patients with chronic hepatitis B were included in the study (mean age: 43±10, M/F: 107/55).The activity of hepatitis on LBS was assessed using Ishak's score.HBsAg and HBcAg immunohistochemistry was performed using an automated immunohistochemical stainer according to the manufacturer's guidelines (streptavidinperoxidase protocol; BenchMark, Ventana, USA).The staining pattern (membranous, cytoplasmic, nuclear, mixed) and the percentage of positive cells were stained semi quantitatively.Results: Mean HBV DNA level was 5.49±1.64log copies/ml.On LBS, 32 out of 162 cases (19%) were HBcAg(+) and 145 (89%) were HBsAg(+).There was a positive correlation between the serum HBV DNA levels and percentage of HBcAg (r = 0.593; p < 0.0001) and HBsAg (r = 0.568; p < 0.0001) positivity.In all cases with HBV DNA >8 log copy/ml HBcAg was found to be positive.There was no HBcAg positivity in cases with HBV DNA < 4.2 log copy/ml.The immunostaining of HBcAg on LBS indicated that serum HBV DNA level is over 6.25 log copy/ml with 91% specificity and 81% sensitivity.When HBcAg is taken 0.01, specificity and sensitivity rose to 96.4% and %81 respectively.The correlation of HBcAg and HBsAg staining was statistically significant (r = 0.470; p < 0.0001).There was no relationship between the staining pattern of HBcAg (nuclear, nuclear dominant mixed, cytoplasmic dominant mixed) and serum HBV DNA level.Whereas, HBsAg staining pattern tended to shift from the membrane to the cytoplasm with higher HBV DNA levels (r = 0.356; p < 0.0001).HBeAg positivity was not related to HBsAg staining, but HBeAg (p < 0.0001).Conclusions: The HBcAg expression in the liver is highly related with HBV DNA level in the serum (100% in HBV DNA >8 log copies/ml; 0% in HBV DNA < 4.2 log copies/ml).HBcAg immunostaining is a reliable method for the demonstration of viral replication.