Why HBV DNA and HbsAg count

[ThomasTu]

@HopeForCure

Hi All,

I have few questions.

What is the important between HBV DNA and HBsAg count. I asked my doctor to check HBsAg count, but she said it is not required and sometime it is misleading.

• As per international standard HBV DNA is considered to start medication
• HBsAg is used to see person is infected or not with Hep B
• What is it matter most HBV DNA or HbsAg count ?
• Which makes more harm to liver HBV DNA or HbsAg count ?

Also new cures which are in pipeline are considering ideal candidates with lower HbsAg.

Dear @HopeForCure,

Determining whether to start medication is a complicated process. I think there are (rightly) moves to simplify how we decide if we should treat people with HBV.

The current recommendations according to European guidelines are this (I hope I do it justice, @PLampertico - happy to be corrected):

• If you’re over 30 and have a virus load over 2000 IU/mL, you can consider treatment
• If you’re HBeAg-postitive and have raised ALT levels and have a virus load over 2000 IU/mL, you should consider treatment
• If you’re HBeAg-negative and have a virus load over 2000 IU/mL, you should consider treatment
• If you have liver cirrhosis or cancer, you should definitely be on treatment
• If you have family history of liver cirrhosis or cancer, you can consider treatment

So you can see from this, you are correct and HBV DNA is considered a major indicator of whether you should be on treatment or not. There have been large studies showing that high HBV DNA levels are linked to worse liver disease in people who are not treated. But the interpretation of these studies is complicated: this doesn’t usually include people in Immune tolerant phase when virus levels are very high, but disease is very low.

You are correct about HBsAg being used to screen for people who are infected with HBV. But recently scientists have been looking at if HBsAg can be used to predict if you can stop viral treatment. Others have also shown there is some link with liver disease progression, but these studies are still being worked on and have not been generalised to the entire population.

I hope this answers your questions and provides some context.

There are always a lot of new developments in trying to lower HBsAg and @john.tavis will be providing a summary of these at the upcoming free community forum: Online workshop on HBV Cure (Free registration, 30th Sept 2021).

Cheers,
Thomas