Repeated Measurements of Hepatitis B Surface Antigen Identify Carriers of Inactive HBV During Long-term Follow-up

Abstract

In a retrospective, dynamic analysis of almost 300 patients with chronic HBV infection, we found that levels of HBsAg <100 IU/mL identify patients with inactive virus with a high level of specificity. HBsAg levels should therefore be used to define phases of HBV infection in HBe antigen-negative patients.

Anti‐viral therapy can be delayed or avoided in a significant proportion of HBeAg‐negative Caucasian patients in the Grey Zone

“…Quantification of serum HBsAg levels provides additional information concerning classification and prognosis of patients with chronic HBV infection and low viral replication. Indeed, either a single point or a dynamic assessment of HBsAg levels has been shown to be useful to differentiate true IC from patients with active chronic hepatitis B . In agreement with these studies, we found that the median HBsAg levels were significantly lower in IC than in GZ patients, both at baseline and at the end of follow‐up.…”

Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance

“…In HBeAg‐negative patients, low qHBsAg (<1,000 IU/mL) and low HBV DNA (≤2,000 IU/mL) suggest inactive CHB. A qHBsAg <100 IU/mL increases the specificity of identifying those with inactive CHB, but reduces sensitivity to 35% . Higher qHBsAg levels have been associated with progression to cirrhosis and HCC.…”

Long‐term outcome of inactive and active, low viraemic HBeAg‐negative‐hepatitis B virus infection: Benign course towards HBsAg clearance

“…However, HBeAg‐negative‐CHB may present major fluctuations of viral replication and alanine‐aminotransferases (ALT) with temporary remissions that mimic Inactive‐Infection and make difficult the differential diagnosis . Furthermore, the management of HBeAg‐negative carriers is challenged by the unpredictable risk of transition from inactive to active infection, as highly variable rates of HBV reactivation were reported . At present the combined HBV‐DNA and ALT monitoring for at least 12 months is recommended by international guidelines for an accurate diagnosis of inactive infection, albeit ALT are not specific markers of virus‐induced liver damage and their fluctuations may be caused by other co‐factors of liver damage .…”

“…HBV‐DNA levels persistently ≤2000‐IU/mL were identified as the virological condition to diagnose Inactive‐Infection . However, growing evidence suggests that viraemia levels persistently ≤20 000‐IU/mL are associated with a benign outcome as in inactive HBV infection …”