Letter to the Editor
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 21, 2022; 28(27): 3532-3534
Published online Jul 21, 2022. doi: 10.3748/wjg.v28.i27.3532
Hepatitis B core-related antigen: Are we near a treatment endpoint?
Tarana Gupta
Tarana Gupta, Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak 124001, Haryana, India
Author contributions: Gupta T wrote and critically revised the manuscript.
Conflict-of-interest statement: The author has no conflicts of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tarana Gupta, Doctor, MBBS, MD, Professor, Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, House No. 1065 A Sector 1, Rohtak 124001, Haryana, India. taranagupta@gmail.com
Received: November 7, 2021
Peer-review started: November 7, 2021
First decision: December 12, 2021
Revised: December 25, 2021
Accepted: June 24, 2022
Article in press: June 24, 2022
Published online: July 21, 2022
Processing time: 252 Days and 19.4 Hours
Abstract

Different serological and virological markers in chronic hepatitis B patients guide staging of viral infection, and initiation and response to therapy. Due to the persistence of intrahepatic covalently closed circular DNA (cccDNA) in the hepatocyte nucleus, hepatitis B is not curable. Even after undetectable hepatitis B virus DNA levels, the persistence of hepatitis B surface antigen and novel markers such as hepatitis B core-related antigen (HBcrAg) indicate the persistence of intrahepatic cccDNA. In this study, HBcrAg levels at baseline and after 24 and 48 wk of antiviral therapy predicted hepatitis B e antigen seroconversion. Due to the poor sensitivity of assays and detectable levels in HBsAg-negative patients, the long-term utility of HBcrAg needs future research.

Keywords: Hepatitis B core-related antigen; Chronic hepatitis B; Covalently closed circular DNA; Hepatitis B e antigen seroconversion; Hepatitis B virus DNA; Pregenomic RNA

Core Tip: This study highlights the predictive role of hepatitis B core-related antigen (HBcrAg) levels at baseline, and after 24 and 48 wk of antiviral therapy for hepatitis B e antigen seroconversion in chronic hepatitis B patients. The issues related to poor sensitivity of assays and detectable levels in hepatitis B surface antigen-negative patients are major concerns. Future research on the utility of HBcrAg in hepatitis B virus (HBV) flare after nucleotide cessation, occult HBV reactivation, and risk of developing hepatocellular carcinoma is also needed.