Why HBV DNA and HbsAg count

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.

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4 posts were split to a new topic: Evidence that HBV is real

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

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2 posts were merged into an existing topic: Evidence that HBV is real

Thank you Thomas, excellent answers.
These are few comments from my side:

  1. if your doctor says that hbsag count is not required and sometime it is misleading, you should change your doctor. He o she is not an expert in HBV management
  2. the quantitative assessment of both hbsag and dna is mandatory to understand the complex interplay between virus and host
  3. Dna, but not hbsag, is responsabile for Disease and complications, this is the reason why current therapy based on nuc is so effective
  4. many new antihbv drugs specifically targeting hbsag are under evaluation
  5. indication to start therapy is not based on dna levels only. We treat all patients in phase 2 and 4, few patients in phase 1 and no patients in phase 3
    Best
    Pietro

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Just a few more more quick pieces of information:

HBsAg (also called HBs and the S antigen) is used as a primary screening tool because the assay for it is quick, easy (just takes a small amount of blood), and relatively inexpensive. These are practical issues that are important when physicians are starting their diagnostic assessment.

HBsAg is the best available marker for a functional cure both becaus studies have indicated that loss of HBsAg is the best readily measured indicator that we have of loss or permanent inactivation of the HBV cccDNA. The cccDNA is a nuclear form of the HBV DNA that is the root cause of HBV persistence. HBsAg is not a perfect marker for a functional cure, but it is the best currently available.

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In my case, my hbssg quntative became low( single digits) and then from dec 20 onwards i have done two six monthly labs, it has become non-reactive i. e less than 0.9, should i consider myself functionally cured? My doc has increased the half yearly testing regime (alt, afp, ultrasound, hbv dna) to yearly now.

Thanks

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Hello there,
I’m glad for your results, but I have a question: were you taking medication?
And if so, what medication are you taking?
Has the doctor stopped you from mediation?
And finally, have you created hbsab?

I said above, I am happy for your results.

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Dear @Rajudiwana,

Thanks for sharing your results and you are correct that they are consistent with a functional cure. Congratulations!

Yours sincerely,
Thomas

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I was never on medication as the labs were always within range in last 8 years after i was diagnosed, regarding hbsab, last year it was around 6.8, after that i didn’t got this done, as doctor didn’t advised to do this.

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Hi Thomas,
Thanks for encouraging words.

Best regards

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Glad you won the fight against this devil. Just few question. Where are you from. Did you followed any specific diet. Were you taking any supplement during these years. What were your base line result [DNA load, HbsAg count, e antigen status ].

Thank you in advance

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Glad you won the fight against this devil. Just few question. Where are you from. Did you followed any specific diet.

None

Were you taking any supplement during these years. 

None

What were your base line result [DNA load, HbsAg count, e antigen status ].

DNA load never went beyond 500 copies, lately they became less than 100
Hbsag count at detection time were in thousands, if i remember it was 8k’s, but lately they were coming into single digits before it became non-reactive i.e less than 0.9,
I was hbeag negative at the time of detection, 8 yrs ago.

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@Rajudiwana, at the point of detection, what was your HBeAb when your HbeAg was non-reactive?

Sorry, I don’t remember the count of HBeAB at the time of detection, as it was around 9 years ago.

@Rajudiwana,

Welcome to the community! Congratulations on your results and status – great news indeed. I hope you celebrated appropriately. I have a couple questions if you don’t mind:

  1. When were you diagnosed?
  2. How long were on treatment before the change in your monitoring schedule?

Thank you.

@PLampertico,

Can you clarify what the phases you mention are? Phases of what? Thank you so much.

Phase 1 corresponds to the previously known Immunotolerant phase, phase 2 is the Hbeag pos CH, phase 3 the Hbeag neg chronic infection, phase 4 tge hbeagbeg CH, see EASL 2017 hbv Guidelines for details

Just to add on to what @PLampertico has said:

Hope this helps,
Thomas

Thanks, my answers are inlined below,

hopefulone
17 October

@Rajudiwana,

Welcome to the community! Congratulations on your results and status – great news indeed. I hope you celebrated appropriately. I have a couple questions if you don’t mind:

  1. When were you diagnosed?

It was in july 2012, with routine checkup done by my employer, but i am sure i would have contacted this many years ago.

  1. How long were on treatment before the change in your monitoring schedule?

My doctor never put me on treatment as i was inactive career based upon half yearly test regime.