The clinical utility of HBsAg quantitation in chronic hepatitis B patients: A review

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Hepatology. 2011 Apr 18. doi: 10.1002/hep.24364. [Epub ahead of print]

The clinical utility of HBsAg quantitation in chronic hepatitis B patients: A

review.

Liaw YF.

Source

Liver Research Unit, Chang Gung Memorial Hospital, Chang Gung University College

of Medicine, Taipei, Taiwan. liveryfl@....

Abstract

This clinically relevant review focuses on recent findings relating to hepatitis

B surface antigen (HBsAg) quantitation in untreated and treated patients with

chronic hepatitis B. Recent studies and emerging data have shown that both HBsAg

and hepatitis B virus (HBV) DNA levels decline along the natural course of

chronic HBV infection, being lowest in inactive phase which is also

characterized by the highest HBsAg/HBV DNA ratio. It was demonstrated that

combined use of HBsAg and HBV DNA levels might help identify true inactive

carriers with high accuracy. Retrospective analyses of HBsAg levels in patients

undergoing therapy suggest a role for HBsAg quantitation in monitoring response

to therapy. Interferon-based therapy results in greater overall decline in serum

HBsAg level than nucleos(t)ide analogs (NAs) . A rapid on-treatment decline in

HBsAg level appears to be predictive of sustained response. With the aid of

HBsAg quantitation, it appears that we could anticipate an individualized

approach to tailoring treatment duration. Early stopping rules being proposed

for patients not responding to pegylated interferon, based on lack of HBsAg

decline, represent a step towards a response-guided approach. The development of

stopping rules for patients treated with NAs would be a desirable step to reduce

the burden of a need for life-long therapy. However, before stopping rules for

anti-viral therapy can be applied, there is still more to learn about the

kinetics of HBsAg decline, in both natural history and response to therapy, to

better define the best timing and relevant HBsAg cut-off levels and how best to

apply these in clinical practice.

(HEPATOLOGY 2011.).

Copyright © 2011 American Association for the Study of Liver Diseases.

PMID: 21503943 [PubMed - as supplied by publisher]