How to Understand Hepatitis B Serological Markers (Hepatitis B Two Pairs and a Half)

🥼 Practice and Clinical
3

Clinical Significance of HBV DNA

A simple explanation first: This test is very important for hepatitis B patients. In addition to the two pairs and a half (serological markers) and liver function tests, DNA testing is indispensable. Dongzhimen Hospital can perform this test, and it is relatively common. Below is some guideline content to help everyone understand its significance simply.

  1. The infectivity level of HBV-infected individuals mainly depends on the HBV DNA level in the blood and is unrelated to ALT/AST/bilirubin levels. That is, even people with normal liver function may have viral replication and be HBV DNA positive.
  2. HBV DNA > 2,000 IU/ml is one of the risk factors for untreated chronic hepatitis B patients progressing to liver cirrhosis.
  3. Guideline recommendation (A1): For HBsAg-positive individuals, including CHB patients receiving antiviral treatment, high-sensitivity HBV DNA detection methods with a wide linear range (quantification lower limit of 10–20 IU/ml) should be used whenever possible.
  4. Guideline recommendation (B1): For those with serum HBV DNA positivity, persistent abnormal ALT (>ULN), and after excluding other causes, antiviral treatment is recommended (B1).
  5. Guideline recommendation: For serum HBV DNA-positive individuals, regardless of ALT level, antiviral treatment is recommended if any of the following conditions are met: (1) family history of hepatitis B-related liver cirrhosis or HCC (B1); (2) age > 30 years (B1); (3) non-invasive indicators or liver histology showing significant liver inflammation (G≥2) or fibrosis (F≥2) (B1); (4) HBV-related extrahepatic manifestations (such as HBV-related glomerulonephritis) (B1).
  6. Antiviral treatment: For HBeAg-positive chronic hepatitis B patients, once HBV DNA is undetectable and seroconversion of HBeAg occurs, if HBsAg is less than 100 IU/ml, the risk of relapse after stopping treatment can be reduced.
  7. For HBeAg-negative chronic hepatitis B patients, generally, longer-term treatment is needed. Antiviral discontinuation can be considered only after HBV DNA is undetectable, HBsAg disappears and/or anti-HBs appears, and at least 6 months of consolidation therapy have been completed.

The above content is sourced from the guidelines. For detailed content, please refer to the guidelines.

Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Infectious Diseases, Chinese Medical Association. Guidelines for the Prevention and Treatment of Chronic Hepatitis B (2022 Edition) [J]. Infectious Disease Information, 2023, 36(1):1-17. DOI:10.3969/j.issn.1007-8134.2023.01.01.

1 Like