Bringing to an end mother‐to‐child transmission of hepatitis B: A role for quantitative hepatitis B surface antigen?

Dusheiko, Geoffrey; Easterbrook, Philippa

doi:10.1002/hep.28732

Cited by 2 publications

(3 citation statements)

References 12 publications

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“…In analogy to this, as per 2016 data, access to HBV DNA measurement remained limited and unaffordable in most resource-limited and high-prevalence regions (US$100-$400 per test). 25 Likewise, a cost effectiveness study from 2016 estimated that the use of HBV DNA as compared to qHBsAg costs approximately USD $20,000 more per infection prevented. 22 A more recent cost effectiveness study highlights that the PAP-VL approach is only cost-effective in 26% of low-and middle-income countries due to high diagnostic cost.…”

Section: Discussionmentioning

confidence: 99%

“…In our NHS Healthcare Trust, the equivalent estimated costs for qualitative HBeAg, qHBsAg and HBV DNA are USD $4.6, $8.8 and $55.9, respectively. In analogy to this, as per 2016 data, access to HBV DNA measurement remained limited and unaffordable in most resource‐limited and high‐prevalence regions (US$100–$400 per test) 25 . Likewise, a cost effectiveness study from 2016 estimated that the use of HBV DNA as compared to qHBsAg costs approximately USD $20,000 more per infection prevented 22 .…”

Section: Discussionmentioning

confidence: 99%

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Role of HBsAg levels in guiding hepatitis B virus prophylaxis in pregnancy: Insights from a multi‐ethnic cohort

Mak,

Koffas,

Dolman

et al. 2023

Journal of Viral Hepatitis

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Pregnant mothers with chronic hepatitis B infection (CHB) need peri‐partum antiviral prophylaxis (PAP) to reduce the risk of mother‐to‐child‐transmission. Currently, PAP is recommended in those with high viral load (VL) that is, HBV DNA >200,000 IU/mL. Quantitative hepatitis B surface antigen (qHBsAg) >10,000 IU/mL, a cut‐off derived primarily from hepatitis B e‐antigen (HBeAg) positive antenatal cohorts in Chinese populations, is advocated as a surrogate marker of VL for guiding PAP. We investigated the utility of qHBsAg to predict high‐VL in a multi‐ethnic urban cohort with CHB. A consecutive cohort of women with CHB was identified from Barts Health NHS Trust databases in the United Kingdom. We included women with paired HBV DNA and qHBsAg during pregnancy. Women already on antiviral at conception were excluded. A total of 769 pregnancies in 678 CHB pregnant mothers (median age 31 years‐old, 8.6% HBeAg+) were included. At median gestational age of 15.3 weeks, HBV DNA was 336 (IQR 44–2998) IU/mL, with 65 (8.5%) being high‐VL. Serum qHBsAg was most useful in Black/Black‐British/Caribbean/African (AUROC 0.946) with 100% sensitivity and 80.6% specificity to predict high‐VL; but it performed less well for other ethnicities: Asian (AUROC 0.877), White (AUROC 0.797) and mixed ethnicities (AUROC 0.742). In conclusion, for settings where healthcare resources are not limited, HBV DNA remains the optimal marker to identify highly viraemic pregnancies for guiding PAP. For resource‐limited settings where the prevailing cost is treatment, serum qHBsAg can be used in Black/Black British/Caribbean/African sub‐cohorts, but not for other ethnicities.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Role of HBsAg levels in guiding hepatitis B virus prophylaxis in pregnancy: Insights from a multi‐ethnic cohort

Mak,

Koffas,

Dolman

et al. 2023

Journal of Viral Hepatitis

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“…This information will be useful in assessing the clinical utility of HCV qualitative versus quantitative RNA assays and optimizing the development of future HCV RDTs for HCVcAg detection, including as a one-step diagnostic strategy in a range of higher prevalence settings. A quantitative HBsAg test is currently under evaluation as a potentially simplified alternative strategy to ascertain high levels of viraemia, rather than a test for HBeAg or HBV DNA [50]. …”

Section: Diagnostic Innovations and Future Developmentsmentioning

confidence: 99%

Diagnosis of viral hepatitis

Easterbrook

Roberts²,

Sands³

et al. 2017

Current Opinion in HIV and AIDS

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Purpose of reviewChronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections and HIV–HBV and HCV coinfection are major causes of chronic liver disease worldwide. Testing and diagnosis is the gateway for access to both treatment and prevention services, but there remains a large burden of undiagnosed infection globally. We review the global epidemiology, key challenges in the current hepatitis testing response, new tools to support the hepatitis global response (2016–2020 Global Hepatitis Health Sector strategy, and 2017 WHO guidelines on hepatitis testing) and future directions and innovations in hepatitis diagnostics.Recent findingsKey challenges in the current hepatitis testing response include lack of quality-assured serological and low-cost virological in-vitro diagnostics, limited facilities for testing, inadequate data to guide country-specific hepatitis testing approaches, stigmatization of those with or at risk of viral hepatitis and lack of guidelines on hepatitis testing for resource-limited settings. The new Global Hepatitis Health Sector strategy sets out goals for elimination of viral hepatitis as a public health threat by 2030 and gives outcome targets for reductions in new infections and mortality, as well as service delivery targets that include testing, diagnosis and treatment. The 2017 WHO hepatitis testing guidelines for adults, adolescents and children in low-income and middle-income countries outline the public health approach to strengthen and expand current testing practices for viral hepatitis and addresses who to test (testing approaches), which serological and virological assays to use (testing strategies) as well as interventions to promote linkage to prevention and care.SummaryFuture directions and innovations in hepatitis testing include strategies to improve access such as through use of existing facility and community-based testing opportunities for hepatitis testing, near-patient or point-of-care assays for virological markers (nucleic acid testing and HCV core antigen), dried blood spot specimens used with different serological and nucleic acid test assays, multiplex and multi-disease platforms to enable testing for multiple analytes/pathogens and potential self-testing for viral hepatitis.

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Bringing to an end mother‐to‐child transmission of hepatitis B: A role for quantitative hepatitis B surface antigen?

Cited by 2 publications

References 12 publications

Role of HBsAg levels in guiding hepatitis B virus prophylaxis in pregnancy: Insights from a multi‐ethnic cohort

Role of HBsAg levels in guiding hepatitis B virus prophylaxis in pregnancy: Insights from a multi‐ethnic cohort

Diagnosis of viral hepatitis

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