Correlation between liver histopathology and hepatitis B viral (HBV) antigen expression in hepatocytes in chronic HBV infection in relation to the phase of viral infection

The correlation between liver histopathology and HBV antigen expression in hepatocytes of patients with chronic HBV infection was explored in this study. Patients with documented chronic HBV infection at six months apart who satisfied the inclusion criteria underwent liver biopsy. The pathologist was blinded to the clinical and serological profile of the patients. Liver histology was assessed by HAI, and immunohistochemistry for HBcAg and HBsAg were done to asses the nuclear and cytoplasmic expression of antigens and its distribution in the hepatocytes. There was strong correlation between the presence of nuclear HBcAg, low disease activity Index by HAI and positive HBeAg and high HBV DNA in the serum. Similarly cytoplasmic HBcAg was strongly correlated with significant liver disease as per HAI and negative HBeAg status. Membranous expression of HBsAg was associated with inflammatory activity. Diffuse expression of HBsAg in the cytoplasm was inversely related with disease activity. Patients in the immunotolerant phase, had predominantly nuclear expression of HBcAg with low HAI, whereas patients in the immune clearance phase had predominantly cytoplasmic expression of HBcAg with higher HAI.