Elsevier

Journal of Hepatology

Volume 55, Issue 5, November 2011, Pages 1121-1131
Journal of Hepatology

Review
Hepatitis B surface antigen quantification: Why and how to use it in 2011 – A core group report

https://doi.org/10.1016/j.jhep.2011.06.006Get rights and content
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open access

Quantitative HBsAg had been suggested to be helpful in management of HBV, but assays were cumbersome. The recent availability of commercial quantitative assays has restarted the interest in quantitative serum hepatitis B surface antigen (HBsAg) as a biomarker for prognosis and treatment response in chronic hepatitis B. HBsAg level reflects the transcriptional activity of cccDNA rather than the absolute amount of cccDNA copies. Serum HBsAg level tends to be higher in hepatitis B e antigen (HBeAg)-positive than HBeAg-negative patients. Among patients with a low HBV DNA (<2000 IU/ml), HBsAg <1000 IU/ml in genotype D HBV infection and HBsAg <100 IU/ml in genotype B/C HBV infection is associated with inactive carrier state in HBeAg-negative patients. The HBsAg reduction by nucleos(t)ide analogues (NA) is not as pronounced as by interferon treatment. On peginterferon treatment, sustained responders tend to show greater HBsAg decline than the non-responders. The optimal on-treatment HBsAg cutoff to predict response needs further evaluation in HBeAg-positive patients, but an absence of HBsAg decline together with a <2 log reduction in HBV DNA at week 12 can serve as stopping rule in HBeAg-negative patients with genotype D HBV infection. A rapid serum HBsAg decline during NA therapy may identify patients who will clear HBsAg in the long-term. There are early reports among Asian patients that an HBsAg level of <100 IU/ml might predict lower risk of relapse after stopping NA treatment. In clinical practice, serum HBsAg level should be used together with, but not as a substitute for, HBV DNA.

Abbreviations

Anti-HBe
antibodies to hepatitis B e antigen
ALT
alanine aminotransferase
cccDNA
covalently closed circular DNA
CHB
chronic hepatitis B
HBV
hepatitis B virus
HBeAg
hepatitis B e antigen
HBsAg
hepatitis B surface antigen
NA
nuclet(s)ide analogues
NPV
negative predictive value
ORF
open reading frame
PPV
positive predictive value

Keywords

Hepatitis B virus
HBsAg
Antiviral treatment
Peginterferon

Cited by (0)

for the Good Practice in using sAg in Chronic Hepatitis B Study Group (GPs-CHB Study Group)